Machine learning model predicts clotting risk during CRRT in ESKD patients: a SHAP-interpretable approach

Ensuring fluent extracorporeal circulation and preventing circuit clotting are important for end-stage kidney disease (ESKD) patients undergoing continuous renal replacement therapy (CRRT). This study aimed to develop a predictive model using machine learning (ML) algorithms to evaluate clotting risk after initiating CRRT, enhancing treatment safety and effectiveness. This study involved 636 ESKD patients who underwent CRRT. Feature selection was conducted via the least absolute shrinkage and selection operator (LASSO) algorithm. ML algorithms, including support vector machine (SVM), extreme gradient boosting (XGBoost), random forest (RF), gradient boosting machine (GBM), decision tree, and logistic regression (LR), were applied to construct models through tenfold cross-validation. Model performance was assessed via the area under the receiver operating characteristic curve (AUC) and additional metrics. The Shapley additive explanation (SHAP) values quantify each feature's contribution. This study included 199 patients with blood clots during extracorporeal circulation, corresponding to an incidence rate of 31.3%. The AUC values were 0.864 (SVM), 0.815 (XGBoost), 0.806 (GBM), 0.778 (RF), 0.732 (Decision Tree), and 0.717 (LR). The SVM exhibited the best performance. The initial dose of low-molecular-weight heparin (LMWH) was identified as the most significant factor influencing coagulation. ML serves as a reliable tool for predicting the risk of extracorporeal circuit clotting in ESKD patients undergoing CRRT. The SHAP method elucidates key risk factors, providing a basis for early clinical intervention.