Accurate prediction of intradialytic hypo- and hypertension in haemodialysis patients: the dual-attention Transformer model

Background: Intradialytic hypotension (IDH) and intradialytic hypertension (IDHTN) are frequent haemodialysis complications, each independently linked to increased cardiovascular risk and all-cause mortality. Existing predictive models often fail to capture the irregular nature of real-world haemodialysis data. The study objective was to develop an advanced machine learning architecture specifically designed for irregular time-series analysis of dialysis. Methods: We conducted a retrospective analysis of 1300 haemodialysis patients, encompassing 182 111 sessions and 1 201 323 timestamped observations. Patients were randomly assigned to training (80%), validation (10%) and testing (10%) cohorts. IDH and IDHTN were defined by systolic blood pressure (BP) changes from pre-dialysis baseline: IDH is defined as a systolic BP