Abstract
Background: Prognosis of the aged population requiring maintenance dialysis has been reportedly poor. We aimed to develop prediction models for one-year cost and one-year mortality in aged individuals requiring dialysis to assist decision-making for deciding whether aged people should receive dialysis or not. Methods: We used data from the National Health Insurance Research Database (NHIRD). We identified patients first enrolled in the NHIRD from 2000–2011 for end-stage renal disease (ESRD) who underwent regular dialysis. A total of 48,153 Patients with ESRD aged ≥65 years with complete age and sex information were included in the ESRD cohort. The total medical cost per patient (measured in US dollars) within one year after ESRD diagnosis was our study’s main outcome variable. We were also concerned with mortality as another outcome. In this study, we compared the performance of the random forest prediction model and of the artificial neural network prediction model for predicting patient cost and mortality. Results: In the cost regression model, the random forest model outperforms the artificial neural network according to the mean squared error and mean absolute error. In the mortality classification model, the receiver operating characteristic (ROC) curves of both models were significantly better than the null hypothesis area of 0.5, and random forest model outperformed the artificial neural network. Random forest model outperforms the artificial neural network models achieved similar performance in the test set across all data. Conclusions: Applying artificial intelligence modeling could help to provide reliable information about one-year outcomes following dialysis in the aged and super-aged populations; those with cancer, alcohol-related disease, stroke, chronic obstructive pulmonary disease (COPD), previous hip fracture, osteoporosis, dementia, and previous respiratory failure had higher medical costs and a high mortality rate.
Highlights
Improving care for patients with chronic kidney disease (CKD) and associated comorbidities might lead to better outcomes and slows the progression of CKD [1]
Dialysis treatment increases the risk of frailty [5,6], functional impairment [7], cognition decline [8], and accidental falls [9] among older adults, as well as increasing medical costs and mortality rates [10]
We identified patients first listed in the National Health Insurance Research Database (NHIRD) between 2000 and 2011 for end-stage renal disease (ESRD) who had undergone regular dialysis (ICD-9-CM Code 585)
Summary
Improving care for patients with chronic kidney disease (CKD) and associated comorbidities might lead to better outcomes and slows the progression of CKD [1]. Clinicians should identify the factors that carry risks of mortality or of increased caregiving constraints and medical costs after older patients have entered dialysis treatment. We aimed to develop prediction models for one-year cost and one-year mortality in aged individuals requiring dialysis to assist decision-making for deciding whether aged people should receive dialysis or not. We compared the performance of the random forest prediction model and of the artificial neural network prediction model for predicting patient cost and mortality. Conclusions: Applying artificial intelligence modeling could help to provide reliable information about one-year outcomes following dialysis in the aged and super-aged populations; those with cancer, alcohol-related disease, stroke, chronic obstructive pulmonary disease (COPD), previous hip fracture, osteoporosis, dementia, and previous respiratory failure had higher medical costs and a high mortality rate
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