Optimizing anemia management using artificial intelligence for patients undergoing hemodialysis

Patients with end-stage kidney disease (ESKD) frequently experience anemia, and maintaining hemoglobin (Hb) levels within a targeted range using erythropoiesis-stimulating agents (ESAs) is challenging. This study introduces a gated recurrent unit-attention-based module (GAM) for efficient anemia management among patients undergoing chronic dialysis and proposes a novel alert system for anticipating the need for red blood cell transfusions. Data on demographic characteristics, dialysis metrics, drug administration, laboratory tests, and transfusion history were retrospectively collected from patients undergoing hemodialysis at Kangwon National University Hospital between 2017 and 2022. After preprocessing, a final dataset of 252 patients was used for model training. Our model functions in two major phases: (1) Hb level prediction and ESA dose recommendation and (2) transfusion alert framework. The GAM model outperformed traditional machine learning algorithms, including linear regression, XGBoost, and multilayer perceptron, in predicting Hb levels (R-squared value = 0.60). The model also demonstrated a recommendation accuracy of 0.78 compared to that of clinical experts, indicating a high degree of concordance with the ESA dosing recommendations. Additionally, the model exhibited considerably high accuracy (0.99) for transfusion alarms. Thus, the GAM model holds promise for improving anemia management in patients with ESKD by optimizing ESA dosages and providing timely transfusion alerts.