Development of a program medical device (Artificial Intelligence) to support optimal ultrafiltration planning in hemodialysis treatment.

 

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Development of a program medical device (Artificial Intelligence) to support optimal ultrafiltration planning in hemodialysis treatment.

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Mariko
Miyazaki
Mariko Miyazaki mariko.miyazaki.d4@tohoku.ac.jp Tohoku University Nephrology Sendai Japan *
Tetsuhiro Tanaka tetsuhiro.tanaka.d3@tohoku.ac.jp Tohoku University Nephrology Sendai Japan -
Taizo Hirata tahirata@hiroshima-u.ac.jp Hiroshima University Hospital Clinical Research Center Hiroshima Japan -
Masaaki Nakayama mnakayama1119@yahoo.co.jp Saint Luke Hospital Nephroloy Tokyo Japan -
Sho Kato sho.kato.b1@tohoku.ac.jp Tohoku University Molecular Medicine and Therapy Sendai Japan -
Takayoshi Asakura takayoshi.asakura.a6@tohoku.ac.jp Tohoku University Molecular Medicine and Therapy Sendai Japan -
Masaomi Nangaku mnangaku@m.u-tokyo.ac.jp Tokyo University Nephrology Tokyo Japan -
Toshio Miyata toshio.miyata.c8@tohoku.ac.jp Tohoku University Molecular Medicine and Therapy Sendai Japan -
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For hemodialysis patients, the optimization of body fluid volume is highly critical, and the ultrafiltration (fluid removal) volume is the most fundamental and important management parameter in dialysis care. However, specialists do not always set target weights for each patient  in dialysis facilities. Furthermore, if hypotension could be predicted in advance during fluid removal after setting a target weight, treatment could be safely performed by adjusting the amount of fluid removal at that time. These predictions have largely relied on the knowledge and experience of specialized physicians and staff. We developed the medical program to get optimized ultrafiltration volume using artificial intelligence (AI).


This AI has been trained on 400,000 instances of dialysis medical data prescribed by specialists.AI has been developed by acquiring patient data from 16 domestic facilities in Japan, totaling approximately 3,000 cases (800,000 dialysis sessions), which accounts for about of the  hemodialysis patients.

For the clinical performance trial, cases of test patient data have been acquired from eight facilities spanning Tohoku, Kanto, Chubu, and Western Japan to avoid regional bias and verify the AI's performance.  The AI references the patient's data from the past five dialysis sessions to predict ultrafiltration volume and other dialysis conditions. The current day's medical data such as current day's before HD body weight, dry weight, time removing body fluid volume are used for prediction. 

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The average absolute error (MAE) of the AI prediction relative to the target ultrafiltration volume prescribed by specialists was approximately 120mL on average, confirming its generalization performance. The preliminary results of the clinical performance trial show that the accuracy rate of 92.2%. There were no bias between sex, regions,facilities. The error in predicting the amount of fluid removal in the next hour from a certain time point was 20 ml per hour. The ability to predict hypotension was 0.90 in precision and 0.73 in recall, and the system was able to accurately predict the occurrence of hypotension 30 minutes later on average.

Based on these results, the developed product aims to utilize AI, which has been trained on a large volume of specialist data, to predict specific ultrafiltration plans based on individual patient data, thereby contributing to the efficiency of the medical setting while maintaining the quality of medical care.

Kewords