Artificial neural network for prediction of equilibrated dialysis dose without intradialytic sample.

Abstract

Post-dialysis urea rebound (PDUR) is a cause of Kt/V overestimation when it is calculated from pre-dialysis and the immediate post-dialysis blood urea collections. Measuring PDUR requires a 30-or 60-min post-dialysis sampling, which is inconvenient. In this study, a supervised neural network was proposed to predict the equilibrated urea (C eq) at 60 min after the end of hemodialysis (HD). Data of 150 patients from a dialysis unit were analyzed. C eq was measured 60 min after each HD session to calculate PDUR, equilibrated urea reduction rate eq (URR), and ( eq Kt/V). The mean percentage of true urea rebound measured after 60 min of HD session was 19.6 10.7. The mean urea rebound observed from the artificial neural network (ANN) was 18.6 13.9%, while the means were 24.8 14.1% and 21.3 3.49% using Smye and Daugirdas methods, respectively. The ANN model achieved a correlation coefficient of 0.97 (P <0.0001), while the Smye and Daugirdas methods yielded R = 0.81 and 0.93, respectively (P <0.0001); the errors of the Smye method were larger than those of the other methods and resulted in a considerable bias in all cases, while the predictive accuracy for ( eq Kt/V) 60 was equally good by the Daugirdas' formula and the ANN . We conclude that the use of the ANN urea estimation yields accurate results when used to calculate ( eq Kt/V).