Machine learning-based risk prediction model for arteriovenous fistula stenosis

Background Arteriovenous fistula stenosis is a common complication in hemodialysis patients, yet effective predictive tools are lacking. This study aims to develop an interpretable machine learning model for stenosis risk prediction. Methods Clinical data from 974 patients (55 features) undergoing arteriovenous fistula dialysis at The Central Hospital of Wuhan (2017-2024) were analyzed retrospectively. The dataset was split into training (70%) and test (30%) sets. Seven models-Random Forest, XGBoost, Support Vector Machine, Logistic Regression, K-Nearest Neighbors, Artificial Neural Network, and Decision Tree-were trained. Performance was evaluated using F1 score, accuracy, specificity, precision, recall, and AUC-ROC. SHAP values identified key predictors in the optimal model. Results XGBoost achieved the highest AUC (0.829, 95% CI 0.785-0.880). SHAP analysis highlighted seven critical predictors: number of surgeries, prothrombin time activity, lymphocyte count, fistula duration, triglycerides, vitamin B12, and C-reactive protein. Conclusion The XGBoost model effectively predicts arteriovenous fistula stenosis risk using clinical data. SHAP explanations enhance clinical interpretability, aiding personalized care strategies.