Deep-learning models for the detection and incidence prediction of chronic kidney disease and type 2 diabetes from retinal fundus images.

Journal: Nature biomedical engineering
PMID: 34131321

Abstract

Regular screening for the early detection of common chronic diseases might benefit from the use of deep-learning approaches, particularly in resource-poor or remote settings. Here we show that deep-learning models can be used to identify chronic kidney disease and type 2 diabetes solely from fundus images or in combination with clinical metadata (age, sex, height, weight, body-mass index and blood pressure) with areas under the receiver operating characteristic curve of 0.85-0.93. The models were trained and validated with a total of 115,344 retinal fundus photographs from 57,672 patients and can also be used to predict estimated glomerulal filtration rates and blood-glucose levels, with mean absolute errors of 11.1-13.4 ml min per 1.73 m and 0.65-1.1 mmol l, and to stratify patients according to disease-progression risk. We evaluated the generalizability of the models for the identification of chronic kidney disease and type 2 diabetes with population-based external validation cohorts and via a prospective study with fundus images captured with smartphones, and assessed the feasibility of predicting disease progression in a longitudinal cohort.

Authors

  • Kang Zhang
    Xifeng District People's Hospital, Qingyang, China.
  • Xiaohong Liu
    Department of Biopharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Wenhua Road, Shenyang 110016, China. Electronic address: lvj221@163.com.
  • Jie Xu
    Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang Province 310000, China.
  • Jin Yuan
    State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sunyat-sen University, Guangzhou, 510060, China.
  • Wenjia Cai
    Shiley Eye Institute, Institute for Engineering in Medicine, Institute for Genomic Medicine, University of California, San Diego, La Jolla, CA 92093, USA.
  • Ting Chen
    CAS Key Laboratory of Tropical Marine Bio-resources and Ecology (LMB), Guangdong Provincial Key Laboratory of Applied Marine Biology (LAMB), South China Sea Institute of Oceanology, Chinese Academy of Sciences, Guangzhou 510301, China. chan1010@scsio.ac.cn.
  • Kai Wang
    Department of Rheumatology, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, China.
  • Yuanxu Gao
    Institute for AI in Medicine and Faculty of Medicine, Macau University of Science and Technology, Macau, China; State Key Laboratory of Eye Health, Eye Hospital and Institute for Advanced Study on Eye Health and Diseases, Wenzhou Medical University, Wenzhou, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China; Department of Big Data and Biomedical AI, College of Future Technology, Peking University and Peking-Tsinghua Center for Life Sciences, Beijing, China.
  • Sheng Nie
    State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease and Nanfang Hospital, Southern Medical University, Guangzhou, China.
  • Xiaodong Xu
    State Key Laboratory of Networking and Switching Technology, Beijing University of Posts and Telecommunications, Beijing, China.
  • Xiaoqi Qin
    State Key Laboratory of Networking and Switching Technology, Beijing University of Posts and Telecommunications, Beijing, China.
  • Yuandong Su
    Center for Clinical Translational Innovations and Biomedical Big Data Center, West China Hospital and Sichuan University, Chengdu, China.
  • Wenqin Xu
    Institute for Genomic Medicine, Institute of Engineering in Medicine, and Shiley Eye Institute, University of California, San Diego, La Jolla, CA, USA.
  • Andrea Olvera
    Center for Biomedicine and Innovations, Faculty of Medicine, Macau University of Science and Technology and University Hospital, Macau, China.
  • Kanmin Xue
    Nuffield Department of Neuroscience, Oxford University, Oxford, UK.
  • Zhihuan Li
    Center for Translational Innovations and Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China; Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China.
  • Meixia Zhang
    Center for Clinical Translational Innovations and Biomedical Big Data Center, West China Hospital and Sichuan University, Chengdu, China.
  • Xiaoxi Zeng
  • Charlotte L Zhang
    Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510005 Guangzhou, China; Shiley Eye Institute, Institute for Engineering in Medicine, Institute for Genomic Medicine, University of California, San Diego, La Jolla, CA 92093, USA.
  • Oulan Li
    Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 510005 Guangzhou, China; Shiley Eye Institute, Institute for Engineering in Medicine, Institute for Genomic Medicine, University of California, San Diego, La Jolla, CA 92093, USA.
  • Edward E Zhang
    Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China.
  • Jie Zhu
    Department of Digestive Diseases, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China.
  • Yiming Xu
    Department of Computer Science and Technology, Tsinghua University, Beijing, China.
  • Daniel Kermany
    Center for Clinical Translational Innovations and Biomedical Big Data Center, West China Hospital and Sichuan University, Chengdu, China.
  • Kaixin Zhou
    Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China.
  • Ying Pan
    Department of Endocrinology, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, China.
  • Shaoyun Li
    The Big Data Research Center, Chongqing Renji affiliated Hospital to the University of Chinese Academy of Sciences, Chongqing, China.
  • Iat Fan Lai
    Ophthalmic Center, Kiang Wu Hospital, Macau, China.
  • Ying Chi
    Peking University First Affiliated Hospital, Beijing, China.
  • Changuang Wang
    Peking University Third Affiliated Hospital, Beijing, China.
  • Michelle Pei
    Center for Biomedicine and Innovations, Faculty of Medicine, Macau University of Science and Technology and University Hospital, Macau, China.
  • Guangxi Zang
    Center for Biomedicine and Innovations, Faculty of Medicine, Macau University of Science and Technology and University Hospital, Macau, China.
  • Qi Zhang
    Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China.
  • Johnson Lau
    Department of Applied Biology and Chemical Technology, Hong Kong Polytechnic University, Hong Kong, China.
  • Dennis Lam
    Department of Applied Biology and Chemical Technology, Hong Kong Polytechnic University, Hong Kong, China.
  • Xiaoguang Zou
    The First People's Hospital of Kashi, Xinjiang, China.
  • Aizezi Wumaier
    Ophthalmic Center of the First People's Hospital of Kashi Prefecture, Kashi Prefecture, Xinjiang, China.
  • Jianquan Wang
    Ophthalmic Center of the First People's Hospital of Kashi Prefecture, Kashi Prefecture, Xinjiang, China.
  • Yin Shen
    Hubei Key Laboratory of Agricultural Bioinformatics, College of Informatics, Huazhong Agricultural University, Wuhan, P. R. China.
  • Fan Fan Hou
    State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease and Nanfang Hospital, Southern Medical University, Guangzhou, China.
  • Ping Zhang
    Department of Computer Science and Engineering, The Ohio State University, USA.
  • Tao Xu
    Department of Urology, Peking University People's Hospital, Beijing, China.
  • Yong Zhou
    National Institutes for Food and Drug Control, Beijing, 100050, China.
  • Guangyu Wang
    State Key Laboratory of Networking and Switching Technology, Beijing University of Posts and Telecommunications, Beijing 100876, China.

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