Background <p>Renal damage in closed spinal dysraphism (CSD), primarily linked to neurogenic bladder dysfunction, significantly impacts long-term patient outcomes by increasing the risk of chronic kidney disease. Identifying patients at highest risk for renal damage is essential for implementing early interventions, improving bladder management strategies, and preserving renal function. This study aims to develop an effective machine learning model to predict renal damage in children with CSD.</p> Methods <p>This retrospective study included 110 children with CSD. We developed four machine learning models (logistic regression, support vector machine, decision tree, and extreme gradient boosting [XGBoost]), and compared their predictive performances. The area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis were used to evaluate predictive performance. The Shapley additive explanations (SHAP) algorithm and Local Interpretable Model-Agnostic Explanations (LIME) were used to interpret the optimal model.</p> Results <p>The XGBoost model showed the best predictive performance (AUC = 0.957) among the four machine learning models. Through the SHAP analysis, abnormal radiological lower urinary tract findings, female sex, and high-grade vesicoureteral reflux were identified as the three most influential features in predicting renal damage.</p> Conclusion <p>Our study effectively developed a model that accurately predicted renal damage in children with CSD based on the XGBoost algorithm, demonstrating its potential to achieve good predictive performance.</p>