THE PREDICTION OF RENAL FUNCTION DECLINE REFLECTING HETEROGENEOUS AGGRAVATION

 

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https://storage.unitedwebnetwork.com/files/1099/302bf2a950e25eb3ff60f96f30e49a66.pdf
THE PREDICTION OF RENAL FUNCTION DECLINE REFLECTING HETEROGENEOUS AGGRAVATION

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Yukihiro
Imakiire
Yukihiro Imakiire imac_yukihiro.12@chiba-u.jp Chiba University Department of Artificial Intelligence Medicine Chiba Japan *
Ayaka Hananoe ayaka.hananoe@riken.jp RIKEN Center for Integrative Medical SciencesPredictive Medicine Special Project Yokohama Japan -
Eiryo Kawakami eiryo.kawakami@chiba-u.jp Chiba University Department of Artificial Intelligence Medicine Chiba Japan -
 
 
 
 
 
 
 
 
 
 
 
 

Diabetic Kidney Disease (DKD) is a broad range of renal impairments associated with diabetes mellitus and accounts for about 50% of end-stage renal disease (ESRD), imposing a substantial burden on both patients and society due to the need for regular dialysis therapy. The prognosis for DKD that has progressed to ESRD is poor, and kidney transplantation remains the only curative treatment for ESRD. Therefore, early prevention and treatment of DKD are of utmost importance. While the classical trajectory of DKD has been based on gradual renal decline, new clinical portraits like Rapid Decliner, which is the fast aggravation even in short period, have increased, and the prevention of DKD exacerbations requires the assessment of such atypical cases. While the previous predictions of changes in renal function targeted the traditional clinical picture, no prognostic models considering clinical divergence (i.e., sequential short-term shifts in renal function) have been reported. The purpose of this study is to develop high-precision prognosis prediction based on time-series models reflecting heterogeneous progression especially for DKD.

We integrated health examination data, including urine tests, collected from three clinics and tracked about 10,000 patients over 20 years. We constructed a time-series model based on Transformer architecture targeting the rate of decline in kidney function (eGFR slope).  The eGFR slope was calculated based on changes over 2 or 3 year period.

This study targeted 9645 patients and extracted those with mild stages (G1 and G2 at baseline). We evaluated the predictive performance of eGFR slope using metrics like Root Mean Squared Error (RMSE) and Mean Absolute Error (MAE), and clarified key contributors to predict renal function prognosis and features of atypical cases (i.e., Rapid Decliner) from blood test items.

Our study proposed the prediction for renal decline considering heterogeneous trajectory adapting to dynamic changes sequentially.

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