Biomarker and clinical data–based predictor tool (MAUXI) for ultrafiltration failure and cardiovascular outcome in peritoneal dialysis patients: a retrospective and longitudinal study

Objectives To develop a machine learning-based software as a medical device to predict the endurance and outcomes of peritoneal dialysis (PD) patients in real time using effluent-measured biomarkers of the mesothelial-to-mesenchymal transition (MMT). Methods Retrospective, longitudinal, triple blind study in two independent hospitals (Spain), designed under information-theoretical approaches for feature selection and machine learning-based modelling techniques. A total of 151 (train set) and 32 (validation) PD patients in 1979–2022 were included. PD outcomes were analysed in four categories (endurance, exit from PD, cause of PD end, technical failure) by using MMT biomarkers in effluents and clinical databases. Results MMT biomarkers and clinical data can predict PD with a mean absolute error of 16.99 months by using an Extra Tree (ET) regressor. Linear discriminant analysis (LDA) discerns among transfer to haemodialysis or death, predicts whether the cause of PD end is ultrafiltration failure (UFF) or cardiovascular disease (CVD) and anticipates the type of CVD (receiver operating characteristic curve under the area>0.71). Discussion Our combination of longitudinal PD datasets, attribute shrinkage and gold-standard algorithms with overfitting testing and class imbalance ensures robust predictions in PD. Biomarkers displayed proper mutual information and SHapley values, indicating that MMT processes may have a causal relationship in the development of UFF and CVD. Conclusions MMT biomarkers and clinical data may be associated in a causal manner with ultrafiltration failure (local effect) and cardiovascular events (systemic effect) in PD. The machine learning-based software MAUXI provides applicability of ET-LDA models with ≤38 variables to predict PD endurance and type of PD technique failure related to peritoneal membrane deterioration.