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Inoue H, Oya M, Aizawa M, Wagatsuma K, Kamimae M, Kashiwagi Y, Ishii M, Wakabayashi H, Fujii T, Suzuki S, Hattori N, Tatsumoto N, Kawakami E, Asanuma K. Predicting dry weight change in Hemodialysis patients using machine learning. BMC Nephrol 2023; 24:196. [PMID: 37386392 PMCID: PMC10308746 DOI: 10.1186/s12882-023-03248-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Machine Learning has been increasingly used in the medical field, including managing patients undergoing hemodialysis. The random forest classifier is a Machine Learning method that can generate high accuracy and interpretability in the data analysis of various diseases. We attempted to apply Machine Learning to adjust dry weight, the appropriate volume status of patients undergoing hemodialysis, which requires a complex decision-making process considering multiple indicators and the patient's physical conditions. METHODS All medical data and 69,375 dialysis records of 314 Asian patients undergoing hemodialysis at a single dialysis center in Japan between July 2018 and April 2020 were collected from the electronic medical record system. Using the random forest classifier, we developed models to predict the probabilities of adjusting the dry weight at each dialysis session. RESULTS The areas under the receiver-operating-characteristic curves of the models for adjusting the dry weight upward and downward were 0.70 and 0.74, respectively. The average probability of upward adjustment of the dry weight had sharp a peak around the actual change over time, while the average probability of downward adjustment of the dry weight formed a gradual peak. Feature importance analysis revealed that median blood pressure decline was a strong predictor for adjusting the dry weight upward. In contrast, elevated serum levels of C-reactive protein and hypoalbuminemia were important indicators for adjusting the dry weight downward. CONCLUSIONS The random forest classifier should provide a helpful guide to predict the optimal changes to the dry weight with relative accuracy and may be useful in clinical practice.
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Affiliation(s)
- Hiroko Inoue
- Department of Nephrology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Megumi Oya
- Department of Artificial Intelligence Medicine, Graduate School of Medicine, Chiba University, Chuo- ku, Chiba, Japan
- Advanced Data Science Project (ADSP), RIKEN Information R&D and Strategy Headquarters, RIKEN, Yokohama, Kanagawa, Japan
| | - Masashi Aizawa
- Department of Nephrology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Kyogo Wagatsuma
- Department of Artificial Intelligence Medicine, Graduate School of Medicine, Chiba University, Chuo- ku, Chiba, Japan
- Advanced Data Science Project (ADSP), RIKEN Information R&D and Strategy Headquarters, RIKEN, Yokohama, Kanagawa, Japan
| | - Masatomo Kamimae
- Department of Artificial Intelligence Medicine, Graduate School of Medicine, Chiba University, Chuo- ku, Chiba, Japan
- Advanced Data Science Project (ADSP), RIKEN Information R&D and Strategy Headquarters, RIKEN, Yokohama, Kanagawa, Japan
| | - Yusuke Kashiwagi
- Department of Nephrology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Masayoshi Ishii
- Department of Nephrology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
- Department of Artificial Kidney, Chiba University Hospital, Chuo-ku, Chiba, Japan
| | - Hanae Wakabayashi
- Department of Nephrology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
- Department of Artificial Kidney, Chiba University Hospital, Chuo-ku, Chiba, Japan
| | - Takayuki Fujii
- Department of Nephrology, Seirei Sakura Citizen hospital, Sakura, Chiba, Japan
| | - Satoshi Suzuki
- Department of Nephrology, Seirei Sakura Citizen hospital, Sakura, Chiba, Japan
| | - Noriyuki Hattori
- Department of Artificial Kidney, Chiba University Hospital, Chuo-ku, Chiba, Japan
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Narihito Tatsumoto
- Department of Nephrology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Eiryo Kawakami
- Department of Artificial Intelligence Medicine, Graduate School of Medicine, Chiba University, Chuo- ku, Chiba, Japan.
- Advanced Data Science Project (ADSP), RIKEN Information R&D and Strategy Headquarters, RIKEN, Yokohama, Kanagawa, Japan.
| | - Katsuhiko Asanuma
- Department of Nephrology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan.
- Department of Artificial Kidney, Chiba University Hospital, Chuo-ku, Chiba, Japan.
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Yasuda S, Inoue K, Matsui I, Matsumoto A, Katsuma Y, Okushima H, Imai A, Sakaguchi Y, Kaimori JY, Yamamoto R, Mizui M, Isaka Y. Hepatic phosphate uptake and subsequent nerve-mediated phosphaturia are crucial for phosphate homeostasis following portal vein passage of phosphate in rats. Sci Rep 2023; 13:5794. [PMID: 37031318 PMCID: PMC10082792 DOI: 10.1038/s41598-023-32856-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/03/2023] [Indexed: 04/10/2023] Open
Abstract
Fibroblast growth factor 23, parathyroid hormone, and 1,25-dihydroxyvitamin D are critical in phosphate homeostasis. Despite these factors' importance, regulators of phosphaturia in the acute postprandial phase remain largely unknown. This study investigated the mechanism of acute phosphate regulation in the postprandial phase in rats. Duodenal administration of radiolabeled phosphate (32P) showed that 32P levels in the inferior vena cava (IVC) blood were lower than those in the portal vein (PV) blood. Serum phosphate concentration transiently increased 5 min after phosphate solution administration through IVC, while it was maintained after the administration through PV. Phosphate administration through both IVC and PV resulted in increased fractional excretion of phosphate (FEPi) at 10 min without elevation of the known circulating factors, but urinary phosphate excretion during the period was 8% of the dose. Experiments using 32P or partial hepatectomy showed that the liver was one of the phosphate reservoirs. The elevation of FEPi and suppression of sodium-phosphate cotransporter 2a in the kidney at 10 min was attenuated in rats with SCH23390, hepatic denervation, or renal denervation, thus indicating that the liver communicated with the kidney via the nervous system to promote phosphaturia. These results revealed previously unknown mechanisms for serum phosphate maintenance.
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Affiliation(s)
- Seiichi Yasuda
- Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Kazunori Inoue
- Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Isao Matsui
- Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
- Transdimensional Life Imaging Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, 2-1 Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Ayumi Matsumoto
- Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yusuke Katsuma
- Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Hiroki Okushima
- Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Atsuhiro Imai
- Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yusuke Sakaguchi
- Department of Inter-Organ Communication Research in Kidney Disease, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Jun-Ya Kaimori
- Department of Inter-Organ Communication Research in Kidney Disease, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Ryohei Yamamoto
- Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
- Health Promotion and Regulation, Department of Health Promotion Medicine, Osaka University Graduate School of Medicine, 1-17 Machikaneyamacho, Toyonaka, Osaka, 560-0043, Japan
- Health and Counseling Center, Osaka University, 1-17 Machikaneyamacho, Toyonaka, Osaka, 560-0043, Japan
| | - Masayuki Mizui
- Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
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Jørgensen HS, Evenepoel P, Komaba H, Mazzaferro S, Vervloet M, Cavalier E, Fukagawa M. Response to Letter to the Editor From Sumi et al: "Lower Bone Turnover and Skeletal PTH Responsiveness in Japanese Compared to European Patients Receiving Hemodialysis". J Clin Endocrinol Metab 2023; 108:e42-e43. [PMID: 36469693 PMCID: PMC9931179 DOI: 10.1210/clinem/dgac698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Hanne Skou Jørgensen
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, 3000 Leuven, Belgium
- Department of Renal Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Pieter Evenepoel
- Correspondence: Pieter Evenepoel, MD, PhD, Department of Medicine, Division of Nephrology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Hirotaka Komaba
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara 259–1193, Japan
| | - Sandro Mazzaferro
- Nephrology Unit at Policlinico Umberto I Hospital, 00185 Rome, Italy
- Department of Translation and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Marc Vervloet
- Department of Nephrology, Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands
| | - Etienne Cavalier
- Department of Biochemistry, Université de Liège, 4000 Liège, Belgium
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara 259–1193, Japan
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Mise K, Yamaguchi Y, Hoshino J, Ueno T, Sekine A, Sumida K, Yamanouchi M, Hayami N, Suwabe T, Hiramatsu R, Hasegawa E, Sawa N, Fujii T, Hara S, Sugiyama H, Makino H, Wada J, Ohashi K, Takaichi K, Ubara Y. Paratubular basement membrane insudative lesions predict renal prognosis in patients with type 2 diabetes and biopsy-proven diabetic nephropathy. PLoS One 2017; 12:e0183190. [PMID: 28813476 PMCID: PMC5557586 DOI: 10.1371/journal.pone.0183190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 07/31/2017] [Indexed: 01/18/2023] Open
Abstract
Aims Glomerular insudative lesions are a pathological hallmark of diabetic nephropathy (DN). However, paratubular basement membrane insudative lesions (PTBMIL) have not attracted much attention, and the association between such lesions and the renal prognosis remains unclear. Methods Among 142 patients with biopsy-proven DN and type 2 diabetes encountered from 1998 to 2011, 136 patients were enrolled in this study. Patients were classified into 3 groups (Group 1: mild, Group 2: moderate, Group 3: severe) according to the extent of cortical and medullary PTBMIL. The endpoint was a decline of the estimated glomerular filtration rate (eGFR) by ≥ 40% from baseline or commencement of dialysis for end-stage renal disease. The Cox proportional hazard model was employed to calculate hazard ratios (HRs) and 95% confidence interval (CIs) for the death-censored endpoint. Results During a median follow-up period of 1.8 years (IQR: 0.9–3.5), the endpoint occurred in 104 patients. Baseline mean eGFR was 43.9 ± 22.8 ml/min/1.73 m2, and 125 patients (92%) had overt proteinuria. After adjusting for known indicators of DN progression, the HR for the endpoint was 2.32 (95% CI: 1.20–4.51) in PTBMIL Group 2 and 3.12 (1.48–6.58) in PTBMIL Group 3 versus PTBMIL Group 1. Furthermore, adding the PTBMIL Group to a multivariate model including known promoters of DN progression improved prediction of the endpoint (c-index increased by 0.02 [95% CI: 0.00–0.04]). Conclusions PTBMIL may be useful for predicting the renal prognosis of patients with biopsy-proven DN, but further investigation of these lesions in various stages of DN is needed.
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Affiliation(s)
- Koki Mise
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- * E-mail: (KM); (YY)
| | - Yutaka Yamaguchi
- Yamaguchi’s Pathology Laboratory, Chiba, Japan
- * E-mail: (KM); (YY)
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | - Toshiharu Ueno
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Akinari Sekine
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | - Keiichi Sumida
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | | | - Noriko Hayami
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | | | | | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Shigeko Hara
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hirofumi Makino
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
- Department of Pathology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Kenmei Takaichi
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
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