Wednesday, 18 March 2020

AI powered tool hailed as major diagnostic advance

The analysis tool, called KidneyIntelX has been developed by RenalytixAI and is expected to be launched in the middle of this year. It is described as a major break-through in this news article. It should help decide what treatment is best for a patient and whether they need medicine, dialysis or a transplant.

So how does this sort of tool work?

It's basically similar to those telephone systems where you get asked a series of questions on what help you want when calling a support helpline, with the answer you give defining what the next group of questions should be. This is how a doctor decides what is wrong with you, or how a research chemist analyses an unknown chemical by starting with a few standard tests, then choosing the next tests to use based on the results of the first texts. Eventually, the doctor or chemist reaches a conclusion, assuming they remember what the next step is after each preliminary test.

But it includes a few extra twists after that.

Initially, doctors give the software the important questions to ask and say what the answers mean, and what questions to ask next. The creators of the tool then fed into the system the medical records and answers given to questions for literally 3 million patient health records. Then the AI system kicks in and looks for common features that might not spring to mind as being related to the problem being studied. The more real cases the AI code (called a neural network) examines, the more likely the system is to spot the important trends such as do your symptoms match those of patients diagnosed as in need of dialysis by their doctor. Or the bit that humans struggle with, is there some common factor in your earlier medical history that hints about the likely outcome? Your medical history and the outcome of the treatment will be added to the system over time. as well.

This is described as the AI system learning how to diagnose and predict the best outcome. It's not got a mind of its own, it is looking for common factors between patients and what the result of certain treatments was, based on, as mentioned earlier, millions of medical records. It does also need a lot of records where the patient didn't have a kidney problem, to avoid false positives. And contrary to popular views on these systems, it does not decide what will happen to you, it advises the doctor on what to do, and the doctor makes the final decision.

It could take a doctor quite some time to read through your medical record, and to spot changes over time. But humans can miss these odd clues occasionally. This sort of software can do this very quickly and is usually very good at spotting the smaller important clues in amongst your entire medical history. So the doctor is presented with the most important data very quickly and can come to a more accurate conclusion. Freeing up more time, leading to more patients getting the treatment they need.

It's not some power-mad living machine trying to rule your life. The cyborgs from Terminator are not making the decisions. ;)

Friday, 14 February 2020

American Kidney Fund Helping People

There were a lot of people getting transplants in America in 2019. Over 24,000 in fact. And not everyone has insurance or funds to cover a transplant. But then there's the American Kidney Fund...

According to this article from Yahoo! the AKF gave grants to 1,400 people to receive kidney transplants and post-transplant care. More than 60% of the people receiving these grants were from racial and ethnic minority groups, who in general have fewer transplants than white Americans. Yet this group are more likely to need a transplant as more have kidney failure! So without these grants, many people would become financially broken and never receive a transplant.

AKF is also fully supporting the objective of finding living kidney donors.

You can find out more about the American Kidney Fund at their website.

Friday, 7 February 2020

Similar Survival Rates Found for Different Dialysis Modes

Is one form of dialysis better than another? Should you always opt for one particular type of dialysis?
This is something every patient wonders about when told they will have to have dialysis. The trouble is when you are first told you need dialysis, you probably have not considered the options until that very moment. And you wonder if you might make the wrong choice.

A recent bit of research looked at 17 other studies of the possible problem and by pooling all the results - 113,578 patients' results over a 21 year period - came to the conclusion that there is no significant difference in the mortality rate between peritoneal dialysis (PD) and in-centre hemodialysis (HD). This could affect the initial counselling of new patients in the run-up to getting dialysis. The research showed that life expectancy was virtually the same for both the therapies.

As PD is a more cost-effective option and helps preserve a normal lifestyle, they concluded that PD should be encouraged. Many people worry that "home treatment" via PD might be riskier than HD, but this appears not to be the case.

Tuesday, 7 January 2020

Do hemodialysis patients need a blood test every month?

Recent research suggests not necessarily.

 Routine monthly blood testing for prevalent patients on hemodialysis (HD) is not associated with a lower risk of death, hyperkalemia, cardiovascular (CV) events, or hospitalization compared with blood testing every 6 weeks, according to a new study.

Among incident patients on HD, monthly testing was associated with an increased risk of hyperkalemia, CV events, and hospitalization compared with testing every 6 weeks.

However, the optimum time interval between tests couldn't really be determined from the research, published  in the article by Thomas A, Silver SA, Perl J, et al. The frequency of routine blood sampling and patient outcomes among maintenance hemodialysis patients [published online November 12, 2019]. Am J Kidney Dis. doi: 10.1053/j.ajkd.2019.08.016, available here 

Wednesday, 25 September 2019

Are patients at for-profit dialysis centers getting less transplants

I have just read a somewhat worrying (and slightly predictable) article.

A report this month says that in the US, patients attending for-profit dialysis centers are less likely to get a transplant than those at nonprofit centers! This is based on a study examining nearly 1,500,000 dialysis patients over a 17 year period. So it's got a fair bit of data behind it. The link at the start of the paragraph is to the abstract (summary) of the research, but there is a bit more detail in the Reuters news report.

A transplant in the long run is cheaper than receiving dialysis for life, but according to one of the authors, Rachel Patzer from Emory University School of Medicine, “The current system has no financial incentive for dialysis providers to educate, to spend time with and to refer patients for transplant.”

Patients at for-profit facilities were 64% less likely to get on a transplant waiting list, 56% less likely to get a transplant from a deceased donor and 48% less likely to receive a kidney transplant from a living donor.

So if you are on dialysis at a for-profit treatment center, ASK about transplant options, don't just sit there assuming that dialysis is your only option.