Abstract: TH-PO664
Discontinuation of Artificial Intelligence (AI) Tool for Anemia Management Results in Higher Drug Exposure, Lower Hemoglobin (Hb)
Session Information
- Anemia and Iron Metabolism
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 200 Anemia and Iron Metabolism
Authors
- Brier, Michael E., University of Louisville, Louisville, Kentucky, United States
- Gaweda, Adam E., University of Louisville, Louisville, Kentucky, United States
- Aronoff, George R., Dosis Inc, San Francisco, California, United States
Background
We innovated a clinical decision support tool for anemia management. This tool uses AI methods to classify patients into multiple dose-response categories combined with predictive control to achieve target Hb over time. The tool was modified for use with long acting epoetin isoforms (epotein beta, Mircera®). We tested the hypothesis that dropping anemia management guidance will decrease quality.
Methods
Data were abstracted from a commercially available software Strategic Anemia Advisor (SAA, Dosis Inc, San Francisco, CA) between Dec 2018 and Mar 2022 on 855 patients in 5 dialysis facilities receiving epoetin beta located in the same geographic area. SAA use was left at the discretion of the facility medical director. Two facilities used SAA over the duration of the data capture (Facility 1 and 2), one facility never used SAA (Facility 3) and two facilities discontinued SAA at month 53 and 54 (Facility 4 and 5). Data were aggregated by month and an indicator of SAA recommendations.
Results
Facilities that used SAA guidance had higher Hb and lower monthly dose of epoetin beta/patient than the facility that did not use SAA (p<0.001). Discontinuation of SAA caused Hb to fall by about 0.6 g/dL and dose increased 30-39 mcg/patient/month. Mean Hb and dose are shown in Table 1. SAA use is shown as a solid line and no SAA use is shown as a dashed line in Figure1.
Conclusion
Discontinuing AI management results in an immediate, detrimental effect on Hb and ESA dose. Those facilities that never used SAA or discontinued use observed an increased dose of epoetin beta and a decrease in Hb obtained. This is likely due to increased manipulation of the dose in resulting in over control the Hb concentration.
| Facility | 1 | 2 | 3 | 4 | 5 | ||
| SAA | Yes | Yes | No | Yes | No | Yes | No |
| Hb (g/dL) | 11.1 | 10.6 | 10.3 | 10.5 | 9.8 | 10.7 | 10.1 |
| Dose (mcg/patient/month) | 47 | 70 | 139 | 65 | 102 | 59 | 89 |
Statistical Analysis Oneway SNK