LLM4CKD: Large Language Models for Early Stage Chronic Kidney Disease Screening

Early screening of chronic kidney disease (CKD) is critical for timely intervention, yet most machine learning (ML) and deep learning (DL) approaches require labeled data and model training, limiting their use in real-world screening settings. This study evaluates the effectiveness of large language models (LLMs) for CKD screening under zero-shot and few-shot in-context learning settings and compares them with traditional ML and DL methods. We propose a framework that uses clinically selected tabular features and structured prompt templates to enable LLM-based inference without task-specific training. LLM performance is evaluated across multiple prompt styles, feature configurations, and data settings, and compared with standard ML, DL, and tabular foundation model (TFM) baselines, and existing CKD screening tools. The results show that LLMs can achieve competitive performance using only a small number of examples, often matching or outperforming traditional approaches in low-data settings. However, their performance remains model-dependent and less stable as input complexity increases. In contrast, ML, DL, and TFM models show more consistent improvement with larger training data. Overall, the findings highlight a trade-off between data efficiency and stability, suggesting that LLMs may serve as a flexible complementary approach for CKD screening when labeled data are limited.

Population Health-Based Machine Learning Reveals Associations Between Psychosocial Factors and Chronic Kidney Disease

Chronic kidney disease (CKD) progresses silently and severely undermines quality of life, making early detection critical for improving patient outcomes. We present a two-part study that combines large-scale telehealth data with advanced machine learning to both classify self-reported CKD status and identify key drivers of disease. Using selected features from the Behavioral Risk Factor Surveillance System (BRFSS 2021: 438,693 samples; BRFSS 2019: 418,268 samples) and the National Health Interview Survey (NHIS 2021: 29,482 samples; NHIS 2020: 31,568 samples), we addressed missing data with nine state-of-the-art imputation methods and mitigated class imbalance via sampling strategies. Our customized stacked ensemble model achieved balanced accuracy of 72.56-76.12%, with corresponding AUROC scores of 79.59-82.29%. SHapley Additive exPlanations (SHAP) analysis, followed by clinical review, highlighted critical predictors, including regular medical check-ups, age, blood pressure, and indicators of mental health stress. These findings deliver a robust and interpretable framework for CKD risk stratification and provide actionable insights into its associated factors.

XEns-CKD: An Explainable Ensemble-Based Approach for Chronic Kidney Disease Stage Detection

Chronic kidney disease (CKD) is a silent disease. Its progression may not significantly hamper a person's daily routine. Human kidney function can be classified as normal or as one of the five stages of CKD. Early detection of the CKD stage can help patients understand the functional status of their kidneys and follow medical advice to slow CKD progression. In this paper, we propose XEns-CKD, a novel ensemble vision transformer-based scheme for CKD stage classification using ultrasound images. Three ViTs were trained on a private ultrasound image dataset using different training parameters. The performance of each ViT was evaluated using macro sensitivity, macro specificity, macro precision, macro F1-score, macro Youden index, the Matthews correlation coefficient (MCC), and macro balanced accuracy. The ensemble model achieved an overall classification accuracy of 86.36%. This work also emphasizes identifying and interpreting kidney regions affected by CKD progression. Explainable artificial intelligence techniques, including LIME, LRP, Attention-Min, and Attention-Max, were used to improve model transparency and clinical trust. An attention map combining the Attention-Min and Attention-Max results effectively identified and interpreted kidney regions affected during CKD progression from one stage to another. The attention map also highlighted the effects of CKD progression in these regions. Compared with existing methods, the proposed method classified the five CKD stages and normal kidney status with a 4% improvement in accuracy.

Explainable AI for Chronic Kidney Disease Prediction Using Simulated Federated Learning

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.

From Many to Meaningful: Feature-Guided Zero-Shot Chronic Kidney Disease Screening Using Large Language Models

Early screening of chronic kidney disease (CKD) is essential for preventing irreversible progression; however, many machine learning (ML)-based screening methods remain difficult to deploy in community and resource-limited screening settings due to their reliance on large labeled datasets, resource-intensive pathology tests, or high-dimensional clinical features, and limited robustness to population and distributional shifts. This study examines the feasibility of using large language models (LLMs) for early-stage CKD screening in a zero-shot setting, without dataset-specific training. We propose a feature-guided zero-shot framework that evaluates LLM performance using a selected set of clinically meaningful, readily available community-based features, rather than exhaustive clinical inputs. Feature selection was guided by ML-based analysis to identify a compact, clinically relevant subset of variables. Tabular patient records were subsequently serialized into text using standardized prompt templates to enable zero-shot inference. The zero-shot performance of four LLMs (LLaMA-3, Qwen-3, Mistral, and GPT-4o-mini) was evaluated using both the full feature set and the selected subset. Generalizability was assessed across three heterogeneous CKD datasets spanning three countries. Across models and datasets, the selected feature set yielded consistent and statistically significant improvements in balanced accuracy and probability estimates, achieving performance levels suitable for screening purposes. These findings suggest that LLMs can support clinically meaningful, training-free CKD screening using minimal community-accessible patient features, offering a practical complement to conventional ML methods in real-world screening contexts.

Evaluating Reliability in Machine Learning Models for Early Chronic Kidney Disease Prediction: A Systematic Review of Data Leakage and Predictor Stability

The early detection of Chronic Kidney Disease using machine learning has attracted significant interest in healthcare-related computer science. Despite rapid advancements in this field, many reported studies remain inconsistent and potentially misleading. A significant drawback is the lack of organized evaluation regarding methodological concerns. Key issues include data leakage, limited access to temporal patient records and inconsistency in reported clinical indicators. This research offers a systematic literature review of existing CKD prediction studies using interpretable machine learning techniques, where nineteen relevant studies were selected via systematic searches across major academic databases. To assess methodological reliability, this study introduces a structured taxonomy of information leakage and a quantitative leakage scoring framework to systematically evaluate reliability across CKD prediction studies. The analysis reveals a strong relationship between leakage and inflated performance. Here, High leakage-studies report an average accuracy of 95.48%, compared to 80.2% for leakage-free studies, reflecting an increase of approximately 15.28%. Furthermore, a cross-study feature stability analysis shows that only a small subset of predictors is consistently reproducible, with over 80% lacking reliability. Overall, the findings suggest that many reported performance improvements stem from methodological limitations rather than true predictive capability.

ChronoMedicalWorld: A Medical World Model for Learning Patient Trajectories from Longitudinal Care Data

Long-horizon clinical simulation -- predicting how a patient's physiology evolves over years under specified interventions -- is central to chronic-disease care, yet existing electronic health record (EHR) models are predominantly discriminative, and general-purpose large language models drift under repeated interventions. We propose the \textbf{ChronoMedicalWorld Model (CMWM)}, an action-conditioned latent world-model framework for learning patient trajectories from longitudinal care data. CMWM couples a joint-embedding state encoder with a wide action encoder that admits both structured intervention indicators and free-text communication embeddings, and trains a recurrent latent transition module under a six-term objective: next-observation supervision, next-latent prediction, SIGReg latent regularisation, and three physiology-aware shape priors (slope, continuity, large-jump penalty). A closed-loop rollout-prefix protocol matches training to deployment, so the model is optimised against the same multi-step error it exhibits at inference. As a concrete case study, we instantiate CMWM for annual estimated glomerular filtration rate (eGFR) trajectory forecasting in chronic kidney disease (CKD). On a 2{,}232-patient nephrology cohort, the CKD instantiation achieves a dynamic-50\% history rollout test mean absolute error (MAE) of 7.384 and root-mean-square error (RMSE) of 10.256, against 7.964 and 11.069 for a tuned GPT-5.5 structured-prompting baseline ($-7.28\%$ MAE, $-7.35\%$ RMSE), with the gain dominated by the dialogue portion of patient--health-coach communication. The framework is not CKD-specific: its architecture, loss design, and training protocol apply to any chronic condition that can be cast as periodic clinical state interleaved with structured and conversational interventions.