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 Nephrology







Penalized Fair Regression for Multiple Groups in Chronic Kidney Disease

Nakamoto, Carter H., Chen, Lucia Lushi, Foryciarz, Agata, Rose, Sherri

arXiv.org Machine Learning

Fair regression methods have the potential to mitigate societal bias concerns in health care, but there has been little work on penalized fair regression when multiple groups experience such bias. We propose a general regression framework that addresses this gap with unfairness penalties for multiple groups. Our approach is demonstrated for binary outcomes with true positive rate disparity penalties. It can be efficiently implemented through reduction to a cost-sensitive classification problem. We additionally introduce novel score functions for automatically selecting penalty weights. Our penalized fair regression methods are empirically studied in simulations, where they achieve a fairness-accuracy frontier beyond that of existing comparison methods. Finally, we apply these methods to a national multi-site primary care study of chronic kidney disease to develop a fair classifier for end-stage renal disease. There we find substantial improvements in fairness for multiple race and ethnicity groups who experience societal bias in the health care system without any appreciable loss in overall fit.


A Clinically Interpretable Deep CNN Framework for Early Chronic Kidney Disease Prediction Using Grad-CAM-Based Explainable AI

Ayub, Anas Bin, Niha, Nilima Sultana, Haque, Md. Zahurul

arXiv.org Artificial Intelligence

Chronic Kidney Disease (CKD) constitutes a major global medical burden, marked by the gradual deterioration of renal function, which results in the impaired clearance of metabolic waste and disturbances in systemic fluid homeostasis. Owing to its substantial contribution to worldwide morbidity and mortality, the development of reliable and efficient diagnostic approaches is critically important to facilitate early detection and prompt clinical management. This study presents a deep convolutional neural network (CNN) for early CKD detection from CT kidney images, complemented by class balancing using Synthetic Minority Over-sampling Technique (SMOTE) and interpretability via Gradient-weighted Class Activation Mapping (Grad-CAM). The model was trained and evaluated on the CT KIDNEY DATASET, which contains 12,446 CT images, including 3,709 cyst, 5,077 normal, 1,377 stone, and 2,283 tumor cases. The proposed deep CNN achieved a remarkable classification performance, attaining 100% accuracy in the early detection of chronic kidney disease (CKD). This significant advancement demonstrates strong potential for addressing critical clinical diagnostic challenges and enhancing early medical intervention strategies.


ClinicalTrialsHub: Bridging Registries and Literature for Comprehensive Clinical Trial Access

Park, Jiwoo, Liu, Ruoqi, Jagdale, Avani, Srisuwananukorn, Andrew, Zhao, Jing, Li, Lang, Zhang, Ping, Kumar, Sachin

arXiv.org Artificial Intelligence

We present ClinicalTrialsHub, an interactive search-focused platform that consolidates all data from ClinicalTrials.gov and augments it by automatically extracting and structuring trial-relevant information from PubMed research articles. Our system effectively increases access to structured clinical trial data by 83.8% compared to relying on ClinicalTrials.gov alone, with potential to make access easier for patients, clinicians, researchers, and policymakers, advancing evidence-based medicine. ClinicalTrialsHub uses large language models such as GPT-5.1 and Gemini-3-Pro to enhance accessibility. The platform automatically parses full-text research articles to extract structured trial information, translates user queries into structured database searches, and provides an attributed question-answering system that generates evidence-grounded answers linked to specific source sentences. We demonstrate its utility through a user study involving clinicians, clinical researchers, and PhD students of pharmaceutical sciences and nursing, and a systematic automatic evaluation of its information extraction and question answering capabilities.


ContextualSHAP : Enhancing SHAP Explanations Through Contextual Language Generation

Dwiyanti, Latifa, Wibisono, Sergio Ryan, Nambo, Hidetaka

arXiv.org Artificial Intelligence

Explainable Artificial Intelligence (XAI) has become an increasingly important area of research, particularly as machine learning models are deployed in high-stakes domains. Among various XAI approaches, SHAP (SHapley Additive exPlanations) has gained prominence due to its ability to provide both global and local explanations across different machine learning models. While SHAP effectively visualizes feature importance, it often lacks contextual explanations that are meaningful for end-users, especially those without technical backgrounds. To address this gap, we propose a Python package that extends SHAP by integrating it with a large language model (LLM), specifically OpenAI's GPT, to generate contextualized textual explanations. This integration is guided by user-defined parameters (such as feature aliases, descriptions, and additional background) to tailor the explanation to both the model context and the user perspective. We hypothesize that this enhancement can improve the perceived understandability of SHAP explanations. To evaluate the effectiveness of the proposed package, we applied it in a healthcare-related case study and conducted user evaluations involving real end-users. The results, based on Likert-scale surveys and follow-up interviews, indicate that the generated explanations were perceived as more understandable and contextually appropriate compared to visual-only outputs. While the findings are preliminary, they suggest that combining visualization with contextualized text may support more user-friendly and trustworthy model explanations.


Training and Evaluation of Guideline-Based Medical Reasoning in LLMs

Staniek, Michael, Sokolov, Artem, Riezler, Stefan

arXiv.org Artificial Intelligence

Machine learning for early prediction in medicine has recently shown breakthrough performance, however, the focus on improving prediction accuracy has led to a neglect of faithful explanations that are required to gain the trust of medical practitioners. The goal of this paper is to teach LLMs to follow medical consensus guidelines step-by-step in their reasoning and prediction process. Since consensus guidelines are ubiquitous in medicine, instantiations of verbalized medical inference rules to electronic health records provide data for fine-tuning LLMs to learn consensus rules and possible exceptions thereof for many medical areas. Consensus rules also enable an automatic evaluation of the model's inference process regarding its derivation correctness (evaluating correct and faithful deduction of a conclusion from given premises) and value correctness (comparing predicted values against real-world measurements). We exemplify our work using the complex Sepsis-3 consensus definition. Our experiments show that small fine-tuned models outperform one-shot learning of considerably larger LLMs that are prompted with the explicit definition and models that are trained on medical texts including consensus definitions. Since fine-tuning on verbalized rule instantiations of a specific medical area yields nearly perfect derivation correctness for rules (and exceptions) on unseen patient data in that area, the bottleneck for early prediction is not out-of-distribution generalization, but the orthogonal problem of generalization into the future by forecasting sparsely and irregularly sampled clinical variables. We show that the latter results can be improved by integrating the output representations of a time series forecasting model with the LLM in a multimodal setup.