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Hirsch JS, Danna SC, Desai N, Gluckman TJ, Jhamb M, Newlin K, Pellechio B, Elbedewe A, Norfolk E. Optimizing Care Delivery in Patients with Chronic Kidney Disease in the United States: Proceedings of a Multidisciplinary Roundtable Discussion and Literature Review. J Clin Med 2024; 13:1206. [PMID: 38592013 PMCID: PMC10932233 DOI: 10.3390/jcm13051206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Approximately 37 million individuals in the United States (US) have chronic kidney disease (CKD). Patients with CKD have a substantial morbidity and mortality, which contributes to a huge economic burden to the healthcare system. A limited number of clinical pathways or defined workflows exist for CKD care delivery in the US, primarily due to a lower prioritization of CKD care within health systems compared with other areas (e.g., cardiovascular disease [CVD], cancer screening). CKD is a public health crisis and by the year 2040, CKD will become the fifth leading cause of years of life lost. It is therefore critical to address these challenges to improve outcomes in patients with CKD. METHODS The CKD Leaders Network conducted a virtual, 3 h, multidisciplinary roundtable discussion with eight subject-matter experts to better understand key factors impacting CKD care delivery and barriers across the US. A premeeting survey identified topics for discussion covering the screening, diagnosis, risk stratification, and management of CKD across the care continuum. Findings from this roundtable are summarized and presented herein. RESULTS Universal challenges exist across health systems, including a lack of awareness amongst providers and patients, constrained care team bandwidth, inadequate financial incentives for early CKD identification, non-standardized diagnostic classification and triage processes, and non-centralized patient information. Proposed solutions include highlighting immediate and long-term financial implications linked with failure to identify and address at-risk individuals, identifying and managing early-stage CKD, enhancing efforts to support guideline-based education for providers and patients, and capitalizing on next-generation solutions. CONCLUSIONS Payers and other industry stakeholders have opportunities to contribute to optimal CKD care delivery. Beyond addressing the inadequacies that currently exist, actionable tactics can be implemented into clinical practice to improve clinical outcomes in patients at risk for or diagnosed with CKD in the US.
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Affiliation(s)
- Jamie S. Hirsch
- Northwell Health, Northwell Health Physician Partners, 100 Community Drive, Floor 2, Great Neck, NY 11021, USA
| | - Samuel Colby Danna
- VA Southeast Louisiana Healthcare System, 2400 Canal Street, New Orleans, LA 70119, USA
| | - Nihar Desai
- Section of Cardiovascular Medicine, Yale School of Medicine, 800 Howard Avenue, Ste 2nd Floor, New Haven, CT 06519, USA
| | - Ty J. Gluckman
- Providence Heart Institute, Center for Cardiovascular Analytics, Research, and Data Science (CARDS), 9205 SW Barnes Road, Suite 598, Portland, OR 97225, USA
| | - Manisha Jhamb
- Division of Renal-Electrolyte, University of Pittsburgh, 3550 Terrace St., Scaife A915, Pittsburgh, PA 15261, USA
| | - Kim Newlin
- Sutter Health, Sutter Roseville Medical Center, 1 Medical Plaza Drive, Roseville, CA 95661, USA
| | - Bob Pellechio
- RWJ Barnabas Health, Cooperman Barnabas Medical Center, 95 Old Short Hills Rd., West Orange, NJ 07052, USA
| | - Ahlam Elbedewe
- The Kinetix Group, 29 Broadway 26th Floor, New York, NY 10006, USA
| | - Evan Norfolk
- Geisinger Medical Center—Nephrology, 100 North Academy Avenue, Danville, PA 17822, USA
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Chu CD, Tuot DS, Tummalapalli SL. Kidney Function Trajectories and Health Care Costs: Identifying High-Need, High-Cost Patients. Kidney Med 2023; 5:100664. [PMID: 37250504 PMCID: PMC10209529 DOI: 10.1016/j.xkme.2023.100664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Affiliation(s)
- Chi D. Chu
- Department of Medicine, University of California, San Francisco, California
- Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, San Francisco, California
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California and San Francisco VA Health Care System, San Francisco, California
- Division of Nephrology, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Delphine S. Tuot
- Department of Medicine, University of California, San Francisco, California
- Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, San Francisco, California
- Division of Nephrology, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Sri Lekha Tummalapalli
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California and San Francisco VA Health Care System, San Francisco, California
- Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, and Division of Nephrology & Hypertension, Department of Medicine, Weill Cornell Medicine, New York, New York
- The Rogosin Institute, New York, New York
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Filler G, Gipson DS, Iyamuremye D, Díaz González de Ferris ME. Artificial Intelligence in Pediatric Nephrology-A Call for Action. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:17-24. [PMID: 36723276 DOI: 10.1053/j.akdh.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/24/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022]
Abstract
Artificial intelligence is playing an increasingly important role in many fields of clinical care to assist health care providers in patient management. In adult-focused nephrology, artificial intelligence is beginning to be used to improve clinical care, hemodialysis prescriptions, and follow-up of transplant recipients. This article provides an overview of medical artificial intelligence applications relevant to pediatric nephrology. We describe the core concepts of artificial intelligence and machine learning and cover the basics of neural networks and deep learning. We also discuss some examples for clinical applications of artificial intelligence in pediatric nephrology, including neonatal kidney function, early recognition of acute kidney injury, renally cleared drug dosing, intrapatient variability, urinary tract infection workup in infancy, and longitudinal disease progression. Furthermore, we consider the future of artificial intelligence in clinical pediatric nephrology and its potential impact on medical practice and address the ethical issues artificial intelligence raises in terms of clinical decision-making, health care provider-patient relationship, patient privacy, and data collection. This article also represents a call for action involving those of us striving to provide optimal services for children, adolescents, and young adults with chronic conditions.
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Affiliation(s)
- Guido Filler
- Division of Pediatric Nephrology, Departments of Paediatrics, Western University, London, Ontario, Canada; Departments of Medicine, Western University, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada.
| | - Debbie S Gipson
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
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Chan MJ, Hu CC, Huang WH, Hsu CW, Yen TH, Weng CH. An artificial intelligence algorithm for analyzing globus pallidus necrosis after carbon monoxide intoxication. Hum Exp Toxicol 2023; 42:9603271231190906. [PMID: 37491827 DOI: 10.1177/09603271231190906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Globus pallidus necrosis (GPN) is one of typical neurological imaging features in patients with carbon monoxide (CO) poisoning. Current clinical guideline recommends neurological imaging examination for CO-intoxicated patients with conscious disturbance rather than routine screening, which may lead to undiagnosed GPN. We aimed to develop an artificial intelligence algorithm for predicting GPN in CO intoxication patients. We included CO intoxication patients with neurological images between 2000 and 2019 in Chang Gung Memorial Hospital. We collected 41 clinical and laboratory parameters on the first day of admission for algorithm development. We used fivefold cross validation and applied several machine learning algorithms. Random forest classifier (RFC) provided the best predictive performance in our cohort. Among the 261 patients with CO intoxication, 52 patients presented with GPN. The artificial intelligence algorithm using the RFC-based AI model achieved an accuracy = 79.2 ± 2.6%, sensitivity = 77.7%, precision score = 81.9 ± 3.4%, and F1 score = 73.2 ± 1.8%. The area under receiver operating characteristic was approximately 0.64. Top five weighted variables were Platelet count, carboxyhemoglobin, Glasgow Coma scale, creatinine, and hemoglobin. Our RFC-based algorithm is the first to predict GPN in patients with CO intoxication and provides fair predictive ability. Further studies are needed to validate our findings.
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Affiliation(s)
- Ming-Jen Chan
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
- Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Ching-Chih Hu
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Wen-Hung Huang
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
- Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Ching-Wei Hsu
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
- Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Tzung-Hai Yen
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
- Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Cheng-Hao Weng
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
- Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
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Exfoliated Kidney Cells from Urine for Early Diagnosis and Prognostication of CKD: The Way of the Future? Int J Mol Sci 2022; 23:ijms23147610. [PMID: 35886957 PMCID: PMC9324667 DOI: 10.3390/ijms23147610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
Chronic kidney disease (CKD) is a global health issue, affecting more than 10% of the worldwide population. The current approach for formal diagnosis and prognostication of CKD typically relies on non-invasive serum and urine biomarkers such as serum creatinine and albuminuria. However, histological evidence of tubulointerstitial fibrosis is the 'gold standard' marker of the likelihood of disease progression. The development of novel biomedical technologies to evaluate exfoliated kidney cells from urine for non-invasive diagnosis and prognostication of CKD presents opportunities to avoid kidney biopsy for the purpose of prognostication. Efforts to apply these technologies more widely in clinical practice are encouraged, given their potential as a cost-effective approach, and no risk of post-biopsy complications such as bleeding, pain and hospitalization. The identification of biomarkers in exfoliated kidney cells from urine via western blotting, enzyme-linked immunosorbent assay (ELISA), immunofluorescence techniques, measurement of cell and protein-specific messenger ribonucleic acid (mRNA)/micro-RNA and other techniques have been reported. Recent innovations such as multispectral autofluorescence imaging and single-cell RNA sequencing (scRNA-seq) have brought additional dimensions to the clinical application of exfoliated kidney cells from urine. In this review, we discuss the current evidence regarding the utility of exfoliated proximal tubule cells (PTC), podocytes, mesangial cells, extracellular vesicles and stem/progenitor cells as surrogate markers for the early diagnosis and prognostication of CKD. Future directions for development within this research area are also identified.
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