Erythropoiesis stimulating agent recommendation model using recurrent neural networks for patient with kidney failure with replacement therapy

Hae Ryong Yun, Gyubok Lee, Myeong Jun Jeon, Hyung Woo Kim, Young Su Joo, Hyoungnae Kim, Tae Ik Chang, Jung Tak Park, Seung Hyeok Han, Shin Wook Kang, Wooju Kim, Tae Hyun Yoo

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


In patients with kidney failure with replacement therapy (KFRT), optimizing anemia management in these patients is a challenging problem because of the complexities of the underlying diseases and heterogeneous responses to erythropoiesis-stimulating agents (ESAs). Therefore, we propose a ESA dose recommendation model based on sequential awareness neural networks. Data from 466 KFRT patients (12,907 dialysis sessions) in seven tertiary-care general hospitals were included in the experiment. First, a Hb prediction model was developed to simulate longitudinal heterogeneous ESA and Hb interactions. Based on the prediction model as a prospective study simulator, we built an ESA dose recommendation model to predict the required amount of ESA dose to reach a target hemoglobin level after 30 days. Each model's performance was evaluated in the mean absolute error (MAE). The MAEs presenting the best results of the prediction and recommendation model were 0.59 (95% confidence interval: 0.56–0.62) g/dL and 43.2 μg (ESAs dose), respectively. Compared to the results in the real-world clinical data, the recommendation model achieved a reduction of ESA dose (Algorithm: 140 vs. Human: 150 μg/month, P < 0.001), a more stable monthly Hb difference (Algorithm: 0.6 vs. Human: 0.8 g/dL, P < 0.001), and an improved target Hb success rate (Algorithm: 79.5% vs. Human: 62.9% for previous month's Hb < 10.0 g/dL; Algorithm: 95.7% vs. Human:73.0% for previous month's Hb 10.0–12.0 g/dL). We developed an ESA dose recommendation model for optimizing anemia management in patients with KFRT and showed its potential effectiveness in a simulated prospective study.

Original languageEnglish
Article number104718
JournalComputers in Biology and Medicine
Publication statusPublished - 2021 Oct

Bibliographical note

Funding Information:
This work has supported by research grant from the Korean Society of Nephrology (Kyowa Hakko Kirin Co., Ltd. 2017).

Publisher Copyright:
© 2021 Elsevier Ltd

All Science Journal Classification (ASJC) codes

  • Computer Science Applications
  • Health Informatics


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