P1380a System for Forecasting of Drug Dosage for Anemia Correction in Patients on Chronic Dialysis

Abstract

Background and Aims Anemia is a most common complication of CKD in patients on chronic dialysis. Adequacy of anemia correction directly affects both patient’s life quality and patient’s long-term survival. The most important aspect of anemia correction is drug therapy. In this work, we present a system for forecasting of iron supplements and ESA (Epoetin alfa) dosage, that is based on logical rules and artificial intelligence (AI) models. Method As an input dataset, system uses patient’s anthropomorphic parameters, results of laboratory studies, and information on previous drug therapy. The output of the system are dosages of ESA an iron supplements that have to be administered in order to bring the patient’s hemoglobin as close as possible to target range of values (100-120 g/l). The system consists of two sequentially triggering forecasting models (for ESA and for iron supplements), where each model is a combination of logical rules and artificial neural network, that has been trained on a data, collected in more than 20 “Nefrosovet” hemodialysis clinics for the period of 3 years. The effect of system usage was examined for the group of 356 hemodialysis patients with median follow-up time of 4 month. The primary end-point was a number of patients in target range of hemoglobin values (100-120 g/l). Results During the study we determined that as a result of using the dose forecasting system, number of patients in target range of hemoglobin values significantly increased from 239 patients at the beginning of system employment to 266 patients at the end of the study (p=.0318). Furthermore, we observed that there was a concomitant effect of system usage – significant reduction of average monthly ESA dosage from 14300 IU at the beginning of system employment to 13900 IU at the end of the study (p=.0331). Conclusion Employment of automated drug dosage forecasting system based on logical rules and AI models, allows to improve the efficiency of anemia correction in hemodialysis patients and reduce the dosage of administered ESA, which, in turn, reduces the risk of possible complications and treatment cost.