Abstract
Chronic kidney disease (CKD) remains a major public health concern, requiring better predictive models for early intervention. This study evaluates a deep learning model (DLM) that utilizes raw chest X-ray (CXR) data to predict moderate to severe kidney function decline. We analyzed data from 79,219 patients with an estimated Glomerular Filtration Rate (eGFR) between 65 and 120, segmented into development (n = 37,983), tuning (n = 15,346), internal validation (n = 14,113), and external validation (n = 11,777) sets. Our DLM, pretrained on CXR-report pairs, was fine-tuned with the development set. We retrospectively examined data spanning April 2011 to February 2022, with a 5-year maximum follow-up. Primary and secondary endpoints included CKD stage 3b progression, ESRD/dialysis, and mortality. The overall concordance index (C-index) values for the internal and external validation sets were 0.903 (95% CI, 0.885-0.922) and 0.851 (95% CI, 0.819-0.883), respectively. In these sets, the incidences of progression to CKD stage 3b at 5 years were 19.2% and 13.4% in the high-risk group, significantly higher than those in the median-risk (5.9% and 5.1%) and low-risk groups (0.9% and 0.9%), respectively. The sex, age, and eGFR-adjusted hazard ratios (HR) for the high-risk group compared to the low-risk group were 16.88 (95% CI, 10.84-26.28) and 7.77 (95% CI, 4.77-12.64), respectively. The high-risk group also exhibited higher probabilities of progressing to ESRD/dialysis or experiencing mortality compared to the low-risk group. Further analysis revealed that the high-risk group compared to the low/median-risk group had a higher prevalence of complications and abnormal blood/urine markers. Our findings demonstrate that a DLM utilizing CXR can effectively predict CKD stage 3b progression, offering a potential tool for early intervention in high-risk populations.