Development and validation of an interpretable predictive machine learning model for successful weaning of continuous renal replacement therapy

Continuous renal replacement therapy (CRRT) is a vital intervention for critically ill patients with severe acute kidney injury, yet no standardized criteria exist to determine the optimal time for its discontinuation. We developed and validated machine learning models to predict successful CRRT weaning, defined as survival without any form of renal replacement therapy for at least seven days after discontinuation. This retrospective multicenter study used data from two French university hospitals and the publicly available MIMIC-IV critical care database. Predictive variables were selected from routinely collected clinical and biological data to ensure real-world applicability. Models were trained on the Rouen cohort and externally validated on the Rennes and MIMIC-IV cohorts. Among the tested algorithms, the random forest model achieved the best performance, with an area under the receiver operating characteristic curve (AUROC) of 0.86 (95% CI, 0.82-0.91) in the training cohort, 0.81 (95% CI, 0.71-0.90) in the Rennes cohort, and 0.72 (95% CI, 0.65-0.78) in the MIMIC cohort. These results demonstrate the feasibility of a robust and interpretable prediction model that relies solely on routinely available data and has potential for integration into clinical workflows to support CRRT weaning decisions.