A recurrent neural network approach to predicting hemoglobin trajectories in patients with End-Stage Renal Disease

Publication date: Available online 19 February 2020Source: Artificial Intelligence in MedicineAuthor(s): Benjamin Lobo, Emaad Abdel-Rahman, Donald Brown, Lori Dunn, Brendan BowmanAbstractThe most severe form of kidney disease, End-Stage Renal Disease (ESRD) is treated with various forms of dialysis – artificial blood cleansing. Dialysis patients suffer many health burdens including high mortality and hospitalization rates, and symptomatic anemia: a low red blood cell count as indicated by a low hemoglobin (Hgb) level. ESRD-induced anemia is treated, with variable patient response, by erythropoiesis stimulating agents (ESAs): expensive injectable medications typically administered during dialysis sessions. The dosing protocol is typically a population level protocol based on original clinical trials, the use of which often results in Hgb cycling. This cycling phenomenon occurs primarily due to the mismatch in the time between dosing decisions and the time it takes for the effects of a dosing change to be fully realized. In this paper we develop a recurrent neural network approach that uses historic data together with future ESA and iron dosing data to predict the 1, 2, and 3 month Hgb levels of patients with ESRD-induced anemia. The results of extensive experimentation indicate that this approach generates predictions that are clinically relevant: the mean absolute error of the predictions is comparable to estimates of the intra-individual variability of the laboratory t...
Source: Artificial Intelligence in Medicine - Category: Bioinformatics Source Type: research

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CONCLUSIONS: Targeting a higher hemoglobin level (11-13 g/dl) with darbepoetin alfa did not improve kidney outcome compared with targeting a lower hemoglobin level (9-11 g/dl) in patients with advanced CKD without diabetes. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: Prevention of ESKD by Darbepoetin Alfa in CKD Patients with Non-diabetic Kidney Disease (PREDICT), NCT01581073. PMID: 32245781 [PubMed - as supplied by publisher]
Source: Clinical Journal of the American Society of Nephrology : CJASN - Category: Urology & Nephrology Authors: Tags: Clin J Am Soc Nephrol Source Type: research
This report describes the study protocol of a randomized prospective multi-centre open-label clinical trial to evaluate whether starting renal replacement therapy with twice-weekly haemodialysis sessions preserves residual renal function better than the standard thrice-weekly regimen. We also explore other clinical parameters, such as concentrations of uremic toxins, dialysis doses, control of anaemia, removal of medium-weight uremic toxins, nutritional status, quality of life, hospital admissions and mortality. Only incident haemodialysis patients who can maintain a urea clearance rate KrU ≥ 2.5 mL/min/1.73&thin...
Source: Trials - Category: Research Source Type: clinical trials
The objectives of the conservative treatment for chronic kidney disease are to slow down the progression of kidney dysfunction, treat complications (anemia, bone diseases, cardiovascular diseases), vaccination for hepatitis B, and preparation for kidney replacement therapy.
Source: Revista da Associacao Medica Brasileira - Category: General Medicine Source Type: research
Abstract Hematopoietic stem cell transplantation is a life-saving therapy for many patients with cancer, as well as patients with some nonmalignant hematologic disorders, such as aplastic anemia, sickle cell disease, and certain congenital immune deficiencies. Kidney injury directly associated with stem cell transplantation includes a wide range of structural and functional abnormalities, which may be vascular (hypertension, thrombotic microangiopathy), glomerular (albuminuria, nephrotic glomerulopathies), and/or tubulointerstitial. AKI occurs commonly after stem cell transplant, affecting 10%-73% of patients. The...
Source: Clinical Journal of the American Society of Nephrology : CJASN - Category: Urology & Nephrology Authors: Tags: Clin J Am Soc Nephrol Source Type: research
A 34 year-old female with Stage V chronic kidney disease secondary to a history of sickle cell anemia and focal segmental glomerulosclerosis and on peritoneal dialysis presented to our hospital for imaging as part of routine evaluation for renal transplant. Upon receiving an MRI of the abdomen to evaluate liver architecture and kidney anatomy, a 6.6 cm left perinephric mass was incidentally found inferomedial to the left kidney and extending caudally (Figure 1). The renal parenchyma and ureter were uninvolved.
Source: Urology - Category: Urology & Nephrology Authors: Tags: Grand Rounds Source Type: research
Abstract INTRODUCTION: Severe uncontrolled secondary hyperparathyroidism and kidney transplantation history are both risk factors for fractures in hemodialyzed patients. Moreover, patients who return to dialysis after transplant failure have more severe infections/anemia and higher mortality risk than transplant-naive patients starting dialysis with native kidneys. In this context, our aim was to test the hypothesis that transplant failure patients have more secondary hyperparathyroidism than transplant-naive patients. METHODS: We retrospectively compared 29 transplant failure patients to 58 transpl...
Source: Nephrologie and Therapeutique - Category: Urology & Nephrology Authors: Tags: Nephrol Ther Source Type: research
Abstract Angiotensin-converting enzyme inhibitors (ACEI) are commonly prescribed drugs for blood pressure (BP) control and renal protection. The use of ACEI is not associated with an increased risk of acute pancreatitis and ACEI-induced angioedema is rare. A 36-year-old woman presented with vomiting, headache, and aphasia. Her BP was 220/100 mm Hg. urine analysis revealed proteinuria (2+), hematuria (3+). Serum creatinine level was at 1125 μmol/L. She had anemia with 6.1 g/dL of hemoglobin and thrombocytopenia (61,000/mm3). Renal histology revealed lesions of thrombotic microangiopathy. The diagnosis of atypica...
Source: Saudi Journal of Kidney Diseases and Transplantation - Category: Urology & Nephrology Authors: Tags: Saudi J Kidney Dis Transpl Source Type: research
Purpose of review Prolyl-hydroxylase inhibitors are a novel class of orally administered drugs that are under development for the treatment of anemia in patients with chronic kidney disease. This review discusses the biology of these drugs and their target – hypoxia-inducible factor and potential advantages and disadvantages of these therapies. Finally, we will discuss current trials in patients with both chronic kidney disease and end-stage renal disease. Recent findings Recent smaller studies have found that prolyl-hydroxylase are as effective as erythropoietin in treating anemia of chronic kidney disease. We ...
Source: Current Opinion in Nephrology and Hypertension - Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by Anil Chandraker and J. Kevin Tucker Source Type: research
Publication date: Available online 1 August 2019Source: American Journal of Kidney DiseasesAuthor(s): David A. Drew, Daniel E. Weiner, Mark J. SarnakPatients with chronic kidney disease (CKD) are at substantially higher risk for developing cognitive impairment compared with the general population, and both lower glomerular filtration rate and the presence of albuminuria are associated with the development of cognitive impairment and poorer cognitive function. Given the excess of vascular disease seen in individuals with CKD, cerebrovascular disease is likely the predominant pathology underlying these associations, though i...
Source: American Journal of Kidney Diseases - Category: Urology & Nephrology Source Type: research
CONCLUSIONS: Tx-ESRD patients have worse quality metrics related to anemia, phosphorus, albumin, and vascular access compared to Nat-ESRD patients. Nephrology care for patients with Tx-ESRD should be improved to address these quality metrics gaps. PMID: 31311008 [PubMed - as supplied by publisher]
Source: American Journal of Nephrology - Category: Urology & Nephrology Authors: Tags: Am J Nephrol Source Type: research
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