Artificial Intelligence for the Artificial Kidney: Pointers to the Future of a Personalized Hemodialysis Therapy

Abstract

Background: Current dialysis devices are not able to react when unexpected changes occur during dialysis treatment or to learn about experience for therapy personalization. Furthermore, great efforts are dedicated to develop miniaturized artificial kidneys to achieve a continuous and personalized dialysis therapy, in order to improve the patient’s quality of life. These innovative dialysis devices will require a real-time monitoring of equipment alarms, dialysis parameters, and patient-related data to ensure patient safety and to allow instantaneous changes of the dialysis prescription for the assessment of their adequacy. The analysis and evaluation of the resulting large-scale data sets enters the realm of “big data” and will require real-time predictive models. These may come from the fields of machine learning and computational intelligence, both included in artificial intelligence, a branch of engineering involved with the creation of devices that simulate intelligent behavior. The incorporation of artificial intelligence should provide a fully new approach to data analysis, enabling future advances in personalized dialysis therapies. With the purpose to learn about the present and potential future impact on medicine from experts in artificial intelligence and machine learning, a scientific meeting was organized in the Hospital Universitari Bellvitge (L’Hospitalet, Barcelona). As an outcome of that meeting, the aim of this review is to investigate artificial intel ligence experiences on dialysis, with a focus on potential barriers, challenges, and prospects for future applications of these technologies. Summary and Key Messages: Artificial intelligence research on dialysis is still in an early stage, and the main challenge relies on interpretability and/or comprehensibility of data models when applied to decision making. Artificial neural networks and medical decision support systems have been used to make predictions about anemia, total body water, or intradialysis hypotension and are promising approaches for the prescription and monitoring of hemodialysis therapy. Current dialysis machines are continuously improving due to innovative technological developments, but patient safety is still a key challenge. Real-time monitoring systems, coupled with automatic instantaneous biofeedback, will allow changing dialysis prescriptions continuously. The integration of vital sign monitoring with dialysis parameters will produce large data sets that will require the use of data analysis techniques, possibly from the area of machine learning, in order to make better decisions and increase the safety of patients.

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

“…Our endeavor is the first in-depth review of the literature gathering all studies using AI in dialysis or kidney transplantation. Two recent papers looked at AI in nephrology, but both focused on AI core concepts, AI perspectives, and algorithms [1,8]. These articles explained in detail AI terminology and most of the algorithms used, also describing some significant clinical challenges, quoting only a few trials on dialysis and KT.…”

“…Artificial intelligence (AI) solutions are currently present in all medical and nonmedical fields. New algorithms have evolved to handle complex medical situations where the medical community has reached a plateau [1]. Medical registries received machine learning (ML) solutions for a better prediction of events that beat human accuracy [2].…”

Machine learning in nephrology: scratching the surface

“…In the conference, the experience of AI in dialysis was reviewed, and the obstacles, challenges, and future applications in this field were discussed. [ 75 ] All the results indicate a wide application and good prospect for AI in renal dialysis. In the future, AI may significantly change clinical practice in terms of hemodialysis.…”

Progress in the Development and Challenges for the Use of Artificial Kidneys and Wearable Dialysis Devices

“…New possibilities will surely arise from the applications of AI and ML to dialysis machines, although, currently, there are hardly any reported previous experiences [34]. What types of AI and ML applications are emerging for dialysis?…”