Predicting Chronic Kidney Disease After Cisplatin Treatment Using Population-Level Data
Bibliographic record
Abstract
Importance: Cisplatin is a widely used treatment for cancer that can permanently damage the kidneys. Treatment modifications and other strategies may prevent chronic kidney disease (CKD) in patients at risk; however, the incidence and predictability of CKD following cisplatin treatment remain poorly understood. Objective: To characterize the incidence of CKD after cisplatin treatment and evaluate prediction models. Design, Setting, and Participants: In this population-based prognostic study, prediction models were developed based on a retrospective cohort study of patients who received cisplatin chemotherapy for nonhematologic cancer in an outpatient setting between July 1, 2014, and June 30, 2017. Models were tested on a temporal-test cohort of patients from Ontario, Canada, who started treatment between July 1, 2017, and June 30, 2020, and an external-test cohort of patients from a single center in the United States. Data were analyzed from May 1, 2021 to May 7, 2025. Exposures: Predictive features included demographics, cancer diagnosis, cisplatin dose and schedule, comorbidities, laboratory testing, and patient-reported symptoms. Main Outcomes and Measures: The outcomes were CKD (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2) and the eGFR after cisplatin treatment. Measures included the area under the receiver operating characteristic curve and the mean absolute error (MAE). Results: The population-level cohort included 9521 patients (median age, 63 years [IQR, 56-70 years]; 4841 men [50.8%]). Among the 9010 patients without pretreatment CKD, 1228 (13.6%) developed CKD, 81 (0.9%) developed grade 4 or worse CKD, and 16 (0.18%) required dialysis. The eGFR decreased by a mean of 8.1 mL/min/1.73 m2 (95% CI, 7.8-8.4 mL/min/1.73 m2). A simple spline-based regression model based solely on the pretreatment eGFR predicted posttreatment CKD in the temporal-test cohort (area under the curve, 0.80 [95% CI, 0.78-0.82]) and the external-test cohort (area under the curve, 0.73 [95% CI, 0.66-0.78]). Similarly, the posttreatment eGFR was predicted by a spline regression based solely on the pretreatment eGFR (temporal-test MAE, 12.6 mL/min/1.73 m2 [95% CI, 12.3-13.0 mL/min/1.73 m2]; external-test MAE, 14.3 mL/min/1.73 m2 [95% CI, 13.2-15.5 mL/min/1.73 m2]). Complex machine learning systems incorporating all features failed to improve predictions over the univariable models. Conclusions and Relevance: This study found that cisplatin treatment was followed by a predictable decrease in the eGFR, placing patients with a lower baseline eGFR at the highest risk of CKD. A simple model based on the pretreatment eGFR predicts CKD risk and could guide clinical decision-making.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".