Artificial Intelligence in Critical Care Nephrology

Artificial intelligence (AI), including machine learning, deep learning, reinforcement learning, and generative AI, has the potential to advance critical care nephrology (CCN) by enhancing prediction accuracy, improving diagnostic capabilities, supporting clinical decision-making, and streamlining workflow processes. Current applications in CCN include acute kidney injury (AKI) prediction, nephrotoxin surveillance, intradialytic hypotension forecasting, and AI-guided dialysis and continuous renal replacement therapy (CRRT) management, with performance often exceeding traditional models. However, the effect on patient-centered outcomes such as mortality, dialysis dependence, and cost-effectiveness remains uncertain. Emerging techniques, such as conformal prediction for calibrated risk estimates, causal inference for intervention modeling, and reinforcement learning for adaptive ultrafiltration, show promise in enhancing reliability, interpretability, and individualized care. Generative AI and large language models extend these applications to clinical documentation, reasoning, and patient education, while raising new challenges, including hallucinations, regulatory oversight, and clinician trust. Persistent barriers such as data heterogeneity, limited external validation, alert fatigue, and economic constraints hinder broad adoption. This review synthesizes the current evidence and outlines four priorities for advancing AI in CCN: 1) rigorous multicenter validation focused on clinical outcomes, 2) integration of uncertainty quantification and causal modeling into AI tools, 3) development of clinician-centered interfaces that minimize cognitive load, and 4) establishment of transparent, adaptive regulatory and governance frameworks. Realizing the promise of AI in CCN will require multidisciplinary collaboration, fairness and generalizability testing, and sustainable implementation strategies that align technological innovation with measurable improvements in patient care.