Comparison of different methods for hemodialysis evaluation by means of ROC curves: From artificial intelligence to current methods

Background: The National Kidney Foundation Guidelines (DOQI) and the European Renal Association (ERA) have set standards for adequacy of hemodialysis treatment. They recommended minimum single pool doses of 1.2 (Kt/Vsp DOQI), and 1.4 (Kt/Vsp ERA) and a "standard" urea removal ratio (URR) o...

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Detalles Bibliográficos
Autores principales: Fernández, Elmer Andrés, Valtuille, Rodolfo, Presedo, Jesús, Willshaw, Peter
Formato: Artículo
Lenguaje:Español
Publicado: 2005
Materias:
R Medicina (General)
Acceso en línea:http://pa.bibdigital.ucc.edu.ar/3989/1/A_Fern%C3%A1ndez_Valtuille_Presedo_Willshaw.pdf
Aporte de:
Producción Académica Universidad Católica de Córdoba (UCCor) de Universidad Católica de Córdoba
id I38-R144-3989
record_format dspace
spelling I38-R144-39892025-04-10T17:59:12Z http://pa.bibdigital.ucc.edu.ar/3989/ Comparison of different methods for hemodialysis evaluation by means of ROC curves: From artificial intelligence to current methods Fernández, Elmer Andrés Valtuille, Rodolfo Presedo, Jesús Willshaw, Peter R Medicina (General) Background: The National Kidney Foundation Guidelines (DOQI) and the European Renal Association (ERA) have set standards for adequacy of hemodialysis treatment. They recommended minimum single pool doses of 1.2 (Kt/Vsp DOQI), and 1.4 (Kt/Vsp ERA) and a "standard" urea removal ratio (URR) of 65%. Here, we compare an Artificial Intelligence Method (AIM) based on an Artificial Neural Network (ANN) and the usual methods for hemodialysis treatment follow-up such as Smye, Daugirdas, standard urea reduction ratio (URR using post-dialysis urea concentration) and modified URR [Cheng et al. 2001] against equilibrated Kt/V and URR calculated using a 60 min post-dialysis urea concentration. Methods: We used ROC analysis to evaluate and compare these methodologies. We also propose a method to find a minimum target dose that maximizes the sensitivity, specificity and positive predictive values of the diagnostic tool. Results: From a URR point of view, the ANN, stdURR and mURR perform almost equally well with an area under the curve (AUC) of 0.90, 0.93 and 0.92, respectively, but the ANN achieved the lowest false positive rate (FPR = 7.94%) and error rate (ER = 12.7%). When Kt/V is used as a dose index, the logarithmic single-and double-pool equations perform almost equally (AUC 0.957 and 0.962), and the ANN method achieves an AUC of 0.934. The lowest FPR was for ANN and Kt/Vsp (4.76%), which also achieved the lowest ER of 6.39%. Conclusions: For both cases (URR and Kt/V), the minimum doses required to achieve the lowest FPR and ER for the standard methods (stdURR and Kt/Vsp) were higher than those reported by the DOQI guidelines, being 70% for stdURR and 1.35 for Kt/Vsp, whereas for those methods using the double-pool Kt/V or equilibrated URR, the dose targets were close to those recommended by DOQI and ERA. Our proposed method for target dose selection is easy to understand, and it takes into account both accuracy and confidence of the adequacy tool. We found the ANN method to be superior to the Smye method for estimation of equilibrated urea, and the results presented here suggest that ANN methods could be useful tools in the analysis of nephrology data. 2005-09-30 info:eu-repo/semantics/article info:eu-repo/semantics/closedAccess application/pdf spa http://pa.bibdigital.ucc.edu.ar/3989/1/A_Fern%C3%A1ndez_Valtuille_Presedo_Willshaw.pdf Fernández, Elmer Andrés ORCID: https://orcid.org/0000-0002-4711-8634 <https://orcid.org/0000-0002-4711-8634>, Valtuille, Rodolfo ORCID: https://orcid.org/0000-0003-2434-9226 <https://orcid.org/0000-0003-2434-9226>, Presedo, Jesús and Willshaw, Peter (2005) Comparison of different methods for hemodialysis evaluation by means of ROC curves: From artificial intelligence to current methods. Clinical Nephrology, 64 (3). pp. 205-213. ISSN 0301-0430 info:eu-repo/semantics/altIdentifier/doi/10.5414/cnp64205
institution Universidad Católica de Córdoba
institution_str I-38
repository_str R-144
collection Producción Académica Universidad Católica de Córdoba (UCCor)
language Español
orig_language_str_mv spa
topic R Medicina (General)
spellingShingle R Medicina (General)
Fernández, Elmer Andrés
Valtuille, Rodolfo
Presedo, Jesús
Willshaw, Peter
Comparison of different methods for hemodialysis evaluation by means of ROC curves: From artificial intelligence to current methods
topic_facet R Medicina (General)
description Background: The National Kidney Foundation Guidelines (DOQI) and the European Renal Association (ERA) have set standards for adequacy of hemodialysis treatment. They recommended minimum single pool doses of 1.2 (Kt/Vsp DOQI), and 1.4 (Kt/Vsp ERA) and a "standard" urea removal ratio (URR) of 65%. Here, we compare an Artificial Intelligence Method (AIM) based on an Artificial Neural Network (ANN) and the usual methods for hemodialysis treatment follow-up such as Smye, Daugirdas, standard urea reduction ratio (URR using post-dialysis urea concentration) and modified URR [Cheng et al. 2001] against equilibrated Kt/V and URR calculated using a 60 min post-dialysis urea concentration. Methods: We used ROC analysis to evaluate and compare these methodologies. We also propose a method to find a minimum target dose that maximizes the sensitivity, specificity and positive predictive values of the diagnostic tool. Results: From a URR point of view, the ANN, stdURR and mURR perform almost equally well with an area under the curve (AUC) of 0.90, 0.93 and 0.92, respectively, but the ANN achieved the lowest false positive rate (FPR = 7.94%) and error rate (ER = 12.7%). When Kt/V is used as a dose index, the logarithmic single-and double-pool equations perform almost equally (AUC 0.957 and 0.962), and the ANN method achieves an AUC of 0.934. The lowest FPR was for ANN and Kt/Vsp (4.76%), which also achieved the lowest ER of 6.39%. Conclusions: For both cases (URR and Kt/V), the minimum doses required to achieve the lowest FPR and ER for the standard methods (stdURR and Kt/Vsp) were higher than those reported by the DOQI guidelines, being 70% for stdURR and 1.35 for Kt/Vsp, whereas for those methods using the double-pool Kt/V or equilibrated URR, the dose targets were close to those recommended by DOQI and ERA. Our proposed method for target dose selection is easy to understand, and it takes into account both accuracy and confidence of the adequacy tool. We found the ANN method to be superior to the Smye method for estimation of equilibrated urea, and the results presented here suggest that ANN methods could be useful tools in the analysis of nephrology data.
format Artículo
author Fernández, Elmer Andrés
Valtuille, Rodolfo
Presedo, Jesús
Willshaw, Peter
author_facet Fernández, Elmer Andrés
Valtuille, Rodolfo
Presedo, Jesús
Willshaw, Peter
author_sort Fernández, Elmer Andrés
title Comparison of different methods for hemodialysis evaluation by means of ROC curves: From artificial intelligence to current methods
title_short Comparison of different methods for hemodialysis evaluation by means of ROC curves: From artificial intelligence to current methods
title_full Comparison of different methods for hemodialysis evaluation by means of ROC curves: From artificial intelligence to current methods
title_fullStr Comparison of different methods for hemodialysis evaluation by means of ROC curves: From artificial intelligence to current methods
title_full_unstemmed Comparison of different methods for hemodialysis evaluation by means of ROC curves: From artificial intelligence to current methods
title_sort comparison of different methods for hemodialysis evaluation by means of roc curves: from artificial intelligence to current methods
publishDate 2005
url http://pa.bibdigital.ucc.edu.ar/3989/1/A_Fern%C3%A1ndez_Valtuille_Presedo_Willshaw.pdf
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