#4747 THE APPLICATION OF MODERN MEDICAL INFORMATION SYSTEMS WITH ARTIFICIAL INTELLIGENCE ELEMENTS FOR PERSONALIZED TREATMENT OF PATIENTS ON HEMODIALYSIS
Authors: Shutov Evgeny , Bolshakov Stepan , Kotlyarova Galina 
Published: June 2023

Abstract

Background and Aims
The quality of life and survival of patients on hemodialysis significantly depend on modern technology. Treatment requires control of dynamically changing large volume of data, which must be analyzed and interpreted in real time. Achieving the ideal balance between adequate fluid removal, effective dialysis dose, and low risk of adverse events on the hemodialysis procedure is a complex multifactorial problem. The heterogeneity of the dialysis population, comorbid burden, the use of concomitant medications, nutritional status and adherence to diet, patient compliance are a noncomplete list of factors that must be considered when setting the dialysis regimen. Thus, despite significant progress in the technical aspects of the “artificial kidney devices”, personalization of the treatment regimen remains an important and difficult task. Introduction of modern automated medical information systems (MIS) for management of treatment and diagnostic process can provide invaluable assistance in treatment process and improve treatment outcomes. The aim of our study was to improve the prevention and treatment of hemodynamic disorders in hemodialysis patients using a special own program “Maximus”, which collects and analyzes indicators from dialysis machines in real time.

Method
The study was conducted from May to November 2022. The study included 120 patients on hemodialysis. The average age of the participants was 62.3±25.4 years. All participants underwent bioimpedance testing with a hydration score (InBody S10) compared to the prescribed dry weight at inclusion. A total of 9360 hemodialysis procedures (all HDF) were analyzed. The data of all procedures were collected directly from dialysis machines and analyzed in MIS in real time, identifying deviations from the target values. Episodes of both hypertension (140/90 mm Hg) and hypotension (100/60 mm Hg) were considered. MIS analyzed the actual duration of the procedure, blood flow rate, volume of fluid removal, rate of ultrafiltration and level of Na. In case of deviations from the established normal values, the system actively notified the doctor (via SMS/messengers) about detected deviations and proposed solutions. The medical staff timely corrected dry weight, duration of procedures, UF rate, volume of fluid removal, sodium content and blood pressure.

Results
In patients with arterial hypertension (63% of patients), mean systolic BP decreased by 12±6 mmHg and diastolic BP by 10±8 mmHg before dialysis procedure. In this group mean systolic BP decreased by 11±10 mmHg and diastolic BP by 9±8 mmHg during the procedure of hemodialysis. In patients with hypotension, due to “dry weight” increase, correction of Na level, stabilization of BP level was achieved, and mean systolic BP increased by 14±5 mmHg, and diastolic BP by 9±5 mmHg before dialysis procedure. Correction of hemodynamically significant parameters led to a decrease in the incidence of both intradialytic hypotension and hypertension during the hemodialysis procedure.

Conclusion
Correction of treatment, carried out using MIS with SMS notification of medical staff, improved hemodynamic parameters. Modern medical information systems with a Decision Support System can improve the quality and efficiency of treatment, reduce the risk of cardiovascular complications in patients on hemodialysis.