*Article* **Development and Validation of a Machine Learning Model Predicting Arteriovenous Fistula Failure in a Large Network of Dialysis Clinics**

**Ricardo Peralta 1, Mario Garbelli 2, Francesco Bellocchio 2, Pedro Ponce 1, Stefano Stuard 3, Maddalena Lodigiani 2, João Fazendeiro Matos 1, Raquel Ribeiro 4, Milind Nikam 5, Max Botler 6, Erik Schumacher 6, Diego Brancaccio <sup>3</sup> and Luca Neri 2,\***


**Abstract: Background:** Vascular access surveillance of dialysis patients is a challenging task for clinicians. We derived and validated an arteriovenous fistula failure model (AVF-FM) based on machine learning. **Methods:** The AVF-FM is an XG-Boost algorithm aimed at predicting AVF failure within three months among in-centre dialysis patients. The model was trained in the derivation set (70% of initial cohort) by exploiting the information routinely collected in the Nephrocare European Clinical Database (EuCliD®). Model performance was tested by concordance statistic and calibration charts in the remaining 30% of records. Features importance was computed using the SHAP method. **Results:** We included 13,369 patients, overall. The Area Under the ROC Curve (AUC-ROC) of AVF-FM was 0.80 (95% CI 0.79–0.81). Model calibration showed excellent representation of observed failure risk. Variables associated with the greatest impact on risk estimates were previous history of AVF complications, followed by access recirculation and other functional parameters including metrics describing temporal pattern of dialysis dose, blood flow, dynamic venous and arterial pressures. **Conclusions:** The AVF-FM achieved good discrimination and calibration properties by combining routinely collected clinical and sensor data that require no additional effort by healthcare staff. Therefore, it can potentially enable risk-based personalization of AVF surveillance strategies.

**Keywords:** machine learning; artificial intelligence; vascular access surveillance; arteriovenous fistula; end stage kidney disease; dialysis; kidney failure
