Accurate early prediction of Acute Kidney Injury (AKI) is critical for timely clinical intervention. However, existing deep learning models struggle with irregularly sampled data and suffer from the opaque "black-box" nature of sequential architectures, strictly limiting clinical trust. To address these challenges, we propose CT-Former, integrating continuous-time modeling with a Causal-Transformer. To handle data irregularity without biased artificial imputation, our framework utilizes a continuous-time state evolution mechanism to naturally track patient temporal trajectories. To resolve the black-box problem, our Causal-Attention module abandons uninterpretable hidden state aggregation. Instead, it generates a directed structural causal matrix to identify and trace the exact historical onset of severe physiological shocks. By establishing clear causal pathways between historical anomalies and current risk predictions, CT-Former provides native clinical interpretability. Training follows a decoupled two-stage protocol to optimize the causal-fusion process independently. Extensive experiments on the MIMIC-IV cohort (N=18,419) demonstrate that CT-Former significantly outperforms state-of-the-art baselines. The results confirm that our explicitly transparent architecture offers an accurate and trustworthy tool for clinical decision-making.
Postoperative acute kidney injury (AKI) after major non-cardiac surgery carries substantial morbidity, yet early intraoperative risk stratification remains difficult. In this retrospective cohort study, we propose SynerT, a waveform-only hybrid temporal backbone that combines a causal dilated TCN with a hierarchy of dilated recurrent layers to encode early intraoperative physiologic trajectories for AKI risk prediction. Building on SynerT, we further design two model variants that extend the backbone with structured clinical context: SynerT-MM, a late-fusion multimodal extension that integrates hemodynamic burden summaries and preoperative covariates, and SynerTStack, a leakage-safe stacked ensemble that combines cross-validated predictions from SynerT-MM with strong tabular baselines at the meta-learning stage. All models are evaluated under a strict leakage-aware framework on VitalDB, a high-fidelity perioperative database, with prediction restricted to information available within the first 60 intraoperative minutes. Among 2,413 waveform-usable cases (180 AKI-positive; 7.46% prevalence), SynerT fell well below strong structured-data baselines, demonstrating that waveform-only temporal modeling is insufficient under strict early constraints. SynerTMM recovered discrimination by incorporating hemodynamic burden summaries and preoperative covariates, and SynerT-Stack achieved the best overall performance across AUROC, AUPRC, and F1-max. Cross-fitted Platt recalibration substantially corrected calibration defects in both multimodal variants, and decision-curve analysis confirmed the recalibrated stacked model delivered the strongest net clinical benefit across low-to-intermediate thresholds.
Quang Minh Nguyen, Duc Minh Le, Ho Nhat Minh Nguyen +2
Chronic Kidney Disease (CKD), characterized by the gradual loss of kidney function, remains a significant public health challenge. Early detection is crucial for preventing severe complications and enhancing patient outcomes. In this study, Federated Learning (FL) with a VotingClassifier was used to predict CKD using a clinical dataset, where Random Forest, AdaBoost, and XGBoost were utilized to compare and identify the best-fitting model for the global server. Additionally, GridSearchCV was applied to optimize the models' performance on the client's side. To enhance model transparency and trustworthiness, explainable AI (XAI) techniques were incorporated to interpret the prediction mechanisms. The global model's average accuracy was 99%, highlighting the potential of interpretable FL models in supporting early CKD diagnosis and advancing data-driven healthcare solutions.
Md Zahid Hasan Ontor, Md Al Amin, Anik Dev Nath +1
Chronic Kidney Disease (CKD) affects nearly 10% of the global population and often progresses to end-stage renal failure. Accurate prognosis prediction is vital for timely interventions and resource optimization. We present a transformer-based framework for predicting CKD progression using multi-modal electronic health records (EHR) from the Seoul National University Hospital OMOP Common Data Model. Our approach (\textbf{ProQ-BERT}) integrates demographic, clinical, and laboratory data, employing quantization-based tokenization for continuous lab values and attention mechanisms for interpretability. The model was pretrained with masked language modeling and fine-tuned for binary classification tasks predicting progression from stage 3a to stage 5 across varying follow-up and assessment periods. Evaluated on a cohort of 91,816 patients, our model consistently outperformed CEHR-BERT, achieving ROC-AUC up to 0.995 and PR-AUC up to 0.989 for short-term prediction. These results highlight the effectiveness of transformer architectures and temporal design choices in clinical prognosis modeling, offering a promising direction for personalized CKD care.