Interpretable machine learning models for the prediction of all-cause mortality and time to death in hemodialysis patients.

Introduction: The elevated mortality and hospitalization rates among hemodialysis (HD) patients underscore the necessity for the development of accurate predictive tools. This study developed two models for predicting all-cause mortality and time to death-one using a comprehensive database and another simpler model based on demographic and clinical data without laboratory tests.

Method: A retrospective cohort study was conducted from January 2017 to June 2023. Two models were created: Model A with 85 variables and Model B with 22 variables. We assessed the models using random forest (RF), support vector machine, and logistic regression, comparing their performance via the AU-ROC. The RF regression model was used to predict time to death. To identify the most relevant factors for prediction, the Shapley value method was used.

Results: Among 359 HD patients, the RF model provided the most reliable prediction. The optimized Model A showed an AU-ROC of 0.86 ± 0.07, a sensitivity of 0.86, and a specificity of 0.75 for predicting all-cause mortality. It also had an R² of 0.59 for predicting time to death. The optimized Model B had an AU-ROC of 0.80 ± 0.06, a sensitivity of 0.81, and a specificity of 0.70 for predicting all-cause mortality. In addition, it had an R² of 0.81 for predicting time to death.

Conclusion: Two new interpretable clinical tools have been proposed to predict all-cause mortality and time to death in HD patients using machine learning models. The minimal and readily accessible data on which Model B is based makes it a valuable tool for integrating into clinical decision-making processes.