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      Is Generative Artificial Intelligence the Next Step Toward a Personalized Hemodialysis?

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          Abstract

          ABSTRACT Artificial intelligence (AI) generative models driven by the integration of AI and natural language processing technologies, such as OpenAI's chatbot generative pre-trained transformer large language model (LLM), are receiving much public attention and have the potential to transform personalized medicine. Dialysis patients are highly dependent on technology and their treatment generates a challenging large volume of data that has to be analyzed for knowledge extraction. We argue that, by integrating the data acquired from hemodialysis treatments with the powerful conversational capabilities of LLMs, nephrologists could personalize treatments adapted to patients' lifestyles and preferences. We also argue that this new conversational AI integrated with a personalized patient-computer interface will enhance patients' engagement and self-care by providing them with a more personalized experience. However, generative AI models require continuous and accurate updates of data, and expert supervision and must address potential biases and limitations. Dialysis patients can also benefit from other new emerging technologies such as Digital Twins with which patients' care can also be addressed from a personalized medicine perspective. In this paper, we will revise LLMs potential strengths in terms of their contribution to personalized medicine, and, in particular, their potential impact, and limitations in nephrology. Nephrologists' collaboration with AI academia and companies, to develop algorithms and models that are more transparent, understandable, and trustworthy, will be crucial for the next generation of dialysis patients. The combination of technology, patient-specific data, and AI should contribute to create a more personalized and interactive dialysis process, improving patients' quality of life.

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          Most cited references40

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          Explainable AI: A Review of Machine Learning Interpretability Methods

          Recent advances in artificial intelligence (AI) have led to its widespread industrial adoption, with machine learning systems demonstrating superhuman performance in a significant number of tasks. However, this surge in performance, has often been achieved through increased model complexity, turning such systems into “black box” approaches and causing uncertainty regarding the way they operate and, ultimately, the way that they come to decisions. This ambiguity has made it problematic for machine learning systems to be adopted in sensitive yet critical domains, where their value could be immense, such as healthcare. As a result, scientific interest in the field of Explainable Artificial Intelligence (XAI), a field that is concerned with the development of new methods that explain and interpret machine learning models, has been tremendously reignited over recent years. This study focuses on machine learning interpretability methods; more specifically, a literature review and taxonomy of these methods are presented, as well as links to their programming implementations, in the hope that this survey would serve as a reference point for both theorists and practitioners.
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            Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): The TRIPOD statement

            Prediction models are developed to aid health-care providers in estimating the probability or risk that a specific disease or condition is present (diagnostic models) or that a specific event will occur in the future (prognostic models), to inform their decision making. However, the overwhelming evidence shows that the quality of reporting of prediction model studies is poor. Only with full and clear reporting of information on all aspects of a prediction model can risk of bias and potential usefulness of prediction models be adequately assessed. The Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) Initiative developed a set of recommendations for the reporting of studies developing, validating, or updating a prediction model, whether for diagnostic or prognostic purposes. This article describes how the TRIPOD Statement was developed. An extensive list of items based on a review of the literature was created, which was reduced after a Web-based survey and revised during a 3-day meeting in June 2011 with methodologists, health-care professionals, and journal editors. The list was refined during several meetings of the steering group and in e-mail discussions with the wider group of TRIPOD contributors. The resulting TRIPOD Statement is a checklist of 22 items, deemed essential for transparent reporting of a prediction model study. The TRIPOD Statement aims to improve the transparency of the reporting of a prediction model study regardless of the study methods used. The TRIPOD Statement is best used in conjunction with the TRIPOD explanation and elaboration document. To aid the editorial process and readers of prediction model studies, it is recommended that authors include a completed checklist in their submission (also available at www.tripod-statement.org).
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              Machine learning for the prediction of volume responsiveness in patients with oliguric acute kidney injury in critical care

              Background and objectives Excess fluid balance in acute kidney injury (AKI) may be harmful, and conversely, some patients may respond to fluid challenges. This study aimed to develop a prediction model that can be used to differentiate between volume-responsive (VR) and volume-unresponsive (VU) AKI. Methods AKI patients with urine output  5 l in the following 6 h in the US-based critical care database (Medical Information Mart for Intensive Care (MIMIC-III)) were considered. Patients who received diuretics and renal replacement on day 1 were excluded. Two predictive models, using either machine learning extreme gradient boosting (XGBoost) or logistic regression, were developed to predict urine output > 0.65 ml/kg/h during 18 h succeeding the initial 6 h for assessing oliguria. Established models were assessed by using out-of-sample validation. The whole sample was split into training and testing samples by the ratio of 3:1. Main results Of the 6682 patients included in the analysis, 2456 (36.8%) patients were volume responsive with an increase in urine output after receiving > 5 l fluid. Urinary creatinine, blood urea nitrogen (BUN), age, and albumin were the important predictors of VR. The machine learning XGBoost model outperformed the traditional logistic regression model in differentiating between the VR and VU groups (AU-ROC, 0.860; 95% CI, 0.842 to 0.878 vs. 0.728; 95% CI 0.703 to 0.753, respectively). Conclusions The XGBoost model was able to differentiate between patients who would and would not respond to fluid intake in urine output better than a traditional logistic regression model. This result suggests that machine learning techniques have the potential to improve the development and validation of predictive modeling in critical care research.
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                Author and article information

                Journal
                ric
                Revista de investigación clínica
                Rev. invest. clín.
                Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (Ciudad de México, Ciudad de México, Mexico )
                0034-8376
                2564-8896
                December 2023
                : 75
                : 6
                : 309-317
                Affiliations
                [4] Barcelona orgnameUniversity of Barcelona orgdiv1Department of Mathematics and Computer Science orgdiv2Artificial Intelligence in Medicine Lab Spain
                [5] Barcelona orgnameUniversitat Politècnica de Catalunya orgdiv1Intelligent Data Science and Artificial Intelligence Research Center Spain
                [3] Barcelona orgnameEurecat Centro Tecnológico de Cataluña orgdiv1Digital Health Unit Spain
                [2] Santander orgnameSpanish Society of Nephrology orgdiv1BigData and Artificial Intelligence Group Spain
                [1] Barcelona orgnameInstitut d'Investigació Biomèdica de Bellvitge Spain
                [6] Barcelona orgnameCentro de Investigación Biomédica en Red Spain
                Article
                S0034-83762023000600309 S0034-8376(23)07500600309
                10.24875/ric.23000162
                c2f5d078-2bc6-48db-a2c2-8d46a48cfd35

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 26 July 2023
                : 27 July 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 40, Pages: 9
                Product

                SciELO Mexico

                Categories
                In-depth review

                Large Language Models,Personalized hemodialysis,Artificial intelligence,Natural language processing

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