Abstract
INTRODUCTION: Intradialytic hypotension (IDH) remains a prevalent complication of hemodialysis, which is associated with adverse outcomes for patients. This study seeks to harness machine learning to construct predictive models for IDH based on multiple definitions. METHODS: In this study, a comprehensive approach was employed, leveraging a dataset comprising 26,690 hemodialysis (HD) sessions for training and testing cohort, with an additional 12,293 HD sessions serving as a temporal validation cohort. Five definitions of IDH were employed, and models for each IDH definition were constructed using ten machine learning algorithms. Subsequently, model interpretation was facilitated. Feature simplification ensued, leading to the creation and evaluation of a streamlined machine learning model. Both the most effective machine learning model and its simplified counterpart underwent temporal validation. RESULTS: Across the five distinct definitions of IDH, the CatBoost model demonstrated superior predictive prowess, generally yielding the highest receiver operating characteristic - area under the curve (ROC-AUC) (Definition 1-5: 0.859, 0.864, 0.880, 0.848, 0.845). Noteworthy is the persistent inclusion of certain features within the top 20 across all definitions, including left ventricular mass index (LVMI), etc. Leveraging these features, we developed robust machine learning models that exhibited good performance (ROC-AUC for Definition 1-5: 0.866, 0.858, 0.874, 0.843, 0.838). Both the leading original machine learning model and the refined simplified machine learning model demonstrated robust performance on a temporal validation set. CONCLUSION: Machine learning emerged as a reliable tool for predicting IDH in HD patients. Notably, LVMI emerged as a crucial feature for effectively predicting IDH. The simplified models are accessible on the provided website.