Response to Letter Regarding “An Artificial Neural Network-Based Model to Predict Chronic Kidney Disease in Aged Cats”

IF 2.1 2区 农林科学 Q1 VETERINARY SCIENCES Journal of Veterinary Internal Medicine Pub Date : 2025-02-01 DOI:10.1111/jvim.70000
Vincent Biourge, Sebastien Delmotte, Alexandre Feugier, Richard Bradley, Molly McAllister, Jonathan Elliott
{"title":"Response to Letter Regarding “An Artificial Neural Network-Based Model to Predict Chronic Kidney Disease in Aged Cats”","authors":"Vincent Biourge,&nbsp;Sebastien Delmotte,&nbsp;Alexandre Feugier,&nbsp;Richard Bradley,&nbsp;Molly McAllister,&nbsp;Jonathan Elliott","doi":"10.1111/jvim.70000","DOIUrl":null,"url":null,"abstract":"<p>We read with interest the letter from Dr. Wun regarding our article “An artificial neural network-based model to predict chronic kidney disease in aged cats” published in Volume 34, Issue 5 of Journal of Veterinary Internal Medicine (JVIM). The issue he raises is a common misconception about the International Renal Interest Society (IRIS) staging system, which should not be used to diagnose chronic kidney disease (CKD). Rather, it is used to stage cats (and dogs) once a clinical diagnosis of CKD has been made. All cats used to derive and validate the algorithm in our study were healthy based on history and physical examination and had serum creatinine concentrations below the diagnostic threshold for CKD according to the reference interval of the laboratory used, and thus did not have a diagnosis of CKD at the time of screening.</p><p>The IRIS staging system accounts for the fact that serum creatinine concentration is insensitive in identifying cats with early CKD. For this reason, stage 1 and the first part of stage 2 CKD for the cat use serum creatinine concentration cut-offs that are below the laboratory reference intervals of many diagnostic laboratories. In such cases, other criteria are required to make a diagnosis of CKD, such as a combination of persistent proteinuria, persistent structural changes identified in the kidney, progressive increases in serum creatinine concentration over time, or persistently increased serum symmetric dimethylarginine (SDMA) concentration. The article on the IRIS website written by Dr. Syme summarizes these clearly: https://www.iris-kidney.com/ckd-early-diagnosis.</p><p>These diagnostic criteria are more subtle and often difficult for general practitioners to clearly define. One of the goals in deriving the algorithm in our paper was to use neural network analysis to identify patterns in the commonly applied screening tests used in general practice to identify the cats that have a high likelihood of developing azotemic CKD within 12 months of the screening event. We wanted to do this based on a single screening event in a population of healthy senior cats recognizing that many owners in Europe do not want their healthy cats to have screening events more frequently than annually. The cats identified by the algorithm have early-stage CKD (as shown by prospectively following and documenting their development of persistent azotaemia, diagnostic of CKD) but are at a stage where plasma creatinine concentration is still within the laboratory reference interval and would thus be considered as normal in a regular senior screening. Neural network analysis evaluated all possible combinations of screening test results to identify at a single visit the combination with the highest specificity while not compromising on sensitivity in predicting the future development of CKD. The use of plasma creatinine concentration alone performed less well than when combined with both urine specific gravity and plasma urea concentration.</p><p>We hope this letter explains our approach and the interpretation of single test results.</p><p>Yours sincerely,</p>","PeriodicalId":49958,"journal":{"name":"Journal of Veterinary Internal Medicine","volume":"39 2","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786674/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Veterinary Internal Medicine","FirstCategoryId":"97","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jvim.70000","RegionNum":2,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"VETERINARY SCIENCES","Score":null,"Total":0}
引用次数: 0

Abstract

We read with interest the letter from Dr. Wun regarding our article “An artificial neural network-based model to predict chronic kidney disease in aged cats” published in Volume 34, Issue 5 of Journal of Veterinary Internal Medicine (JVIM). The issue he raises is a common misconception about the International Renal Interest Society (IRIS) staging system, which should not be used to diagnose chronic kidney disease (CKD). Rather, it is used to stage cats (and dogs) once a clinical diagnosis of CKD has been made. All cats used to derive and validate the algorithm in our study were healthy based on history and physical examination and had serum creatinine concentrations below the diagnostic threshold for CKD according to the reference interval of the laboratory used, and thus did not have a diagnosis of CKD at the time of screening.

The IRIS staging system accounts for the fact that serum creatinine concentration is insensitive in identifying cats with early CKD. For this reason, stage 1 and the first part of stage 2 CKD for the cat use serum creatinine concentration cut-offs that are below the laboratory reference intervals of many diagnostic laboratories. In such cases, other criteria are required to make a diagnosis of CKD, such as a combination of persistent proteinuria, persistent structural changes identified in the kidney, progressive increases in serum creatinine concentration over time, or persistently increased serum symmetric dimethylarginine (SDMA) concentration. The article on the IRIS website written by Dr. Syme summarizes these clearly: https://www.iris-kidney.com/ckd-early-diagnosis.

These diagnostic criteria are more subtle and often difficult for general practitioners to clearly define. One of the goals in deriving the algorithm in our paper was to use neural network analysis to identify patterns in the commonly applied screening tests used in general practice to identify the cats that have a high likelihood of developing azotemic CKD within 12 months of the screening event. We wanted to do this based on a single screening event in a population of healthy senior cats recognizing that many owners in Europe do not want their healthy cats to have screening events more frequently than annually. The cats identified by the algorithm have early-stage CKD (as shown by prospectively following and documenting their development of persistent azotaemia, diagnostic of CKD) but are at a stage where plasma creatinine concentration is still within the laboratory reference interval and would thus be considered as normal in a regular senior screening. Neural network analysis evaluated all possible combinations of screening test results to identify at a single visit the combination with the highest specificity while not compromising on sensitivity in predicting the future development of CKD. The use of plasma creatinine concentration alone performed less well than when combined with both urine specific gravity and plasma urea concentration.

We hope this letter explains our approach and the interpretation of single test results.

Yours sincerely,

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
求助全文
约1分钟内获得全文 去求助
来源期刊
CiteScore
4.50
自引率
11.50%
发文量
243
审稿时长
22 weeks
期刊介绍: The mission of the Journal of Veterinary Internal Medicine is to advance veterinary medical knowledge and improve the lives of animals by publication of authoritative scientific articles of animal diseases.
期刊最新文献
Corticosteroid Administration Enhances the Glycemic, Insulinemic, and Incretin Responses to a High-Protein Mixed Meal in Adult Horses Blood Carboxyhemoglobin Concentrations as a Diagnostic Biomarker of Hemolytic Anemias in Cats Daily Heart Rate Variability in Dogs With Atrial Fibrillation Factors Affecting the Quality of Histopathologic Specimens Obtained via Small Intestinal Endoscopic Biopsy in Dogs and Cats Risk Factors and Long-Term Outcomes in Horses After the 2021 Outbreak of Equine Herpesvirus 1 Myeloencephalopathy, Valencia, Spain
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1