• Alper Tuna Güven, Murat Özdede, Yusuf Ziya Şener, Ali Osman Yıldırım, Sabri Engin Altıntop, Berkay Yeşilyurt, Oğuz Abdullah Uyaroğlu, and Mine Durusu Tanrıöver.
• Başkent University Faculty of Medicine, Department of Internal Medicine, Division of General Internal Medicine. Electronic address: alper.tuna.guven@gmail.com.
• Eur. J. Intern. Med. 2023 Aug 1; 114: 748374-83.

BackgroundRenin-angiotensin-aldosterone system inhibitors (RAASi) are commonly used medications. Renal adverse events associated with RAASi are hyperkalemia and acute kidney injury. We aimed to evaluate the performance of machine learning (ML) algorithms in order to define event associated features and predict RAASi associated renal adverse events.Materials And MethodsData of patients recruited from five internal medicine and cardiology outpatient clinics were evaluated retrospectively. Clinical, laboratory, and medication data were acquired via electronic medical records. Dataset balancing and feature selection for machine learning algorithms were performed. Random forest (RF), k-nearest neighbor (kNN), naïve Bayes (NB), extreme gradient boosting (xGB), support vector machine (SVM), neural network (NN), and logistic regression (LR) were used to create a prediction model.Results409 patients were included, and 50 renal adverse events occurred. The most important features predicting the renal adverse events were the index K and glucose levels, as well as having uncontrolled diabetes mellitus. Thiazides reduced RAASi associated hyperkalemia. kNN, RF, xGB and NN algorithms have the highest and similar AUC (≥ 98%), recall (≥ 94%), specifity (≥ 97%), precision (≥ 92%), accuracy (≥ 96%) and F1 statistics (≥ 94%) performance metrics for prediction.ConclusionRAASi associated renal adverse events can be predicted prior to medication initiation by machine learning algorithms. Further prospective studies with large patient numbers are needed to create scoring systems as well as for their validation.Copyright © 2023 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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