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      Using Artificial Intelligence Resources in Dialysis and Kidney Transplant Patients: A Literature Review

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          Abstract

          Background

          The purpose of this review is to depict current research and impact of artificial intelligence/machine learning (AI/ML) algorithms on dialysis and kidney transplantation. Published studies were presented from two points of view: What medical aspects were covered? What AI/ML algorithms have been used?

          Methods

          We searched four electronic databases or studies that used AI/ML in hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT). Sixty-nine studies were split into three categories: AI/ML and HD, PD, and KT, respectively. We identified 43 trials in the first group, 8 in the second, and 18 in the third. Then, studies were classified according to the type of algorithm.

          Results

          AI and HD trials covered: (a) dialysis service management, (b) dialysis procedure, (c) anemia management, (d) hormonal/dietary issues, and (e) arteriovenous fistula assessment. PD studies were divided into (a) peritoneal technique issues, (b) infections, and (c) cardiovascular event prediction. AI in transplantation studies were allocated into (a) management systems (ML used as pretransplant organ-matching tools), (b) predicting graft rejection, (c) tacrolimus therapy modulation, and (d) dietary issues.

          Conclusions

          Although guidelines are reluctant to recommend AI implementation in daily practice, there is plenty of evidence that AI/ML algorithms can predict better than nephrologists: volumes, Kt/V, and hypotension or cardiovascular events during dialysis. Altogether, these trials report a robust impact of AI/ML on quality of life and survival in G5D/T patients. In the coming years, one would probably witness the emergence of AI/ML devices that facilitate the management of dialysis patients, thus increasing the quality of life and survival.

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          Most cited references83

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          Big data and new knowledge in medicine: the thinking, training, and tools needed for a learning health system.

          Big data in medicine--massive quantities of health care data accumulating from patients and populations and the advanced analytics that can give those data meaning--hold the prospect of becoming an engine for the knowledge generation that is necessary to address the extensive unmet information needs of patients, clinicians, administrators, researchers, and health policy makers. This article explores the ways in which big data can be harnessed to advance prediction, performance, discovery, and comparative effectiveness research to address the complexity of patients, populations, and organizations. Incorporating big data and next-generation analytics into clinical and population health research and practice will require not only new data sources but also new thinking, training, and tools. Adequately utilized, these reservoirs of data can be a practically inexhaustible source of knowledge to fuel a learning health care system.
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            An international observational study suggests that artificial intelligence for clinical decision support optimizes anemia management in hemodialysis patients.

            Managing anemia in hemodialysis patients can be challenging because of competing therapeutic targets and individual variability. Because therapy recommendations provided by a decision support system can benefit both patients and doctors, we evaluated the impact of an artificial intelligence decision support system, the Anemia Control Model (ACM), on anemia outcomes. Based on patient profiles, the ACM was built to recommend suitable erythropoietic-stimulating agent doses. Our retrospective study consisted of a 12-month control phase (standard anemia care), followed by a 12-month observation phase (ACM-guided care) encompassing 752 patients undergoing hemodialysis therapy in 3 NephroCare clinics located in separate countries. The percentage of hemoglobin values on target, the median darbepoetin dose, and individual hemoglobin fluctuation (estimated from the intrapatient hemoglobin standard deviation) were deemed primary outcomes. In the observation phase, median darbepoetin consumption significantly decreased from 0.63 to 0.46 μg/kg/month, whereas on-target hemoglobin values significantly increased from 70.6% to 76.6%, reaching 83.2% when the ACM suggestions were implemented. Moreover, ACM introduction led to a significant decrease in hemoglobin fluctuation (intrapatient standard deviation decreased from 0.95 g/dl to 0.83 g/dl). Thus, ACM support helped improve anemia outcomes of hemodialysis patients, minimizing erythropoietic-stimulating agent use with the potential to reduce the cost of treatment.
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              Application of Machine-Learning Models to Predict Tacrolimus Stable Dose in Renal Transplant Recipients

              Tacrolimus has a narrow therapeutic window and considerable variability in clinical use. Our goal was to compare the performance of multiple linear regression (MLR) and eight machine learning techniques in pharmacogenetic algorithm-based prediction of tacrolimus stable dose (TSD) in a large Chinese cohort. A total of 1,045 renal transplant patients were recruited, 80% of which were randomly selected as the “derivation cohort” to develop dose-prediction algorithm, while the remaining 20% constituted the “validation cohort” to test the final selected algorithm. MLR, artificial neural network (ANN), regression tree (RT), multivariate adaptive regression splines (MARS), boosted regression tree (BRT), support vector regression (SVR), random forest regression (RFR), lasso regression (LAR) and Bayesian additive regression trees (BART) were applied and their performances were compared in this work. Among all the machine learning models, RT performed best in both derivation [0.71 (0.67–0.76)] and validation cohorts [0.73 (0.63–0.82)]. In addition, the ideal rate of RT was 4% higher than that of MLR. To our knowledge, this is the first study to use machine learning models to predict TSD, which will further facilitate personalized medicine in tacrolimus administration in the future.
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                Author and article information

                Contributors
                Journal
                Biomed Res Int
                Biomed Res Int
                BMRI
                BioMed Research International
                Hindawi
                2314-6133
                2314-6141
                2020
                10 June 2020
                : 2020
                : 9867872
                Affiliations
                1Department of Interventional Cardiology-Cardiovascular Diseases Institute, Iasi, Romania
                2“Grigore T. Popa” University of Medicine, Iasi, Romania
                3Faculty of Computer Science, “Alexandru Ioan Cuza” University of Iasi, Romania
                4Center for Studies and Interreligious and Intercultural Dialogue, University of Bucharest, Romania
                5Institute of Gastroenterology and Hepatology, Iasi, Romania
                6Department of Internal Medicine-Nephrology, Iasi, Romania
                7Nephrology Clinic, Dialysis and Renal Transplant Center-‘C.I. Parhon' University Hospital, Iasi, Romania
                8The Academy of Romanian Scientists (AOSR), Romania
                Author notes

                Academic Editor: Rafia Al-Lamki

                Author information
                https://orcid.org/0000-0002-3424-1588
                https://orcid.org/0000-0003-0280-9279
                https://orcid.org/0000-0002-0597-8839
                https://orcid.org/0000-0002-9985-2486
                Article
                10.1155/2020/9867872
                7303737
                32596403
                c7477efe-1960-40fd-8435-fd3835eca7dd
                Copyright © 2020 Alexandru Burlacu et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 March 2020
                : 15 May 2020
                : 25 May 2020
                Funding
                Funded by: Unitatea Executiva pentru Finantarea Invatamantului Superior, a Cercetarii, Dezvoltarii si Inovarii
                Award ID: 167/2017
                Award ID: PN-III-P4-ID-PCE-2016-0908
                Funded by: Ministry of Research and Innovation
                Funded by: European Regional Development Fund
                Award ID: 2/Axa 1/31.07.2017/107124
                Award ID: 107124
                Funded by: Romanian Academy of Medical Sciences
                Categories
                Review Article

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