Community-based early-stage chronic kidney disease screening using explainable machine learning for low-resource settings

BACKGROUND: Early detection of chronic kidney disease (CKD) is essential for preventing progression to end-stage renal disease. However, existing screening tools-primarily developed using populations from high-income countries-often underperform in Bangladesh and South Asia, where risk profiles differ. Moreover, many machine learning-based CKD studies rely heavily on pathology-test variables and are developed using hospital-based datasets, limiting their applicability for community-level screening and for settings where laboratory testing is not readily accessible. OBJECTIVE: To develop and evaluate an explainable machine learning (ML) framework for community-based early-stage CKD screening that derives and evaluates optimized predictor subsets from both all available variables and variables excluding pathology tests, enabling accurate and practical risk assessment in low-resource settings. METHODS: A community-based CKD dataset from Bangladesh was used to develop predictive models. Variables were organized into clinically meaningful feature groups, and ten complementary feature selection methods were applied to identify robust predictor subsets. Twelve ML classifiers were evaluated using nested cross-validation. Model performance was benchmarked against established CKD screening tools and externally validated on three independent datasets from India, the UAE, and Bangladesh. SHAP (SHapley Additive exPlanations) was used to interpret model predictions. RESULTS: The best-performing model using the optimized feature subset derived from all variables achieved a balanced accuracy of 90.4%, while the subset derived from variables excluding pathology tests achieved comparable performance (89.23%), demonstrating the feasibility of accurate CKD risk prediction using minimal non-laboratory features. The proposed approach outperformed existing screening tools while requiring fewer and more accessible inputs. External validation demonstrated strong generalizability, with sensitivities ranging from 78% to 98%. SHAP analysis identified clinically meaningful predictors consistent with established CKD risk factors. CONCLUSIONS: Accurate, interpretable, and scalable early-stage CKD screening is achievable using only non-pathology-test features. This framework demonstrates the potential for community-level CKD screening in resource-constrained settings.