BACKGROUND AND OBJECTIVES:Variable hemoglobin (Hb) response to erythropoiesis stimulating agents may result in adverse outcomes. The utility of model predictive control for drug dosing was previously demonstrated. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a double-blinded, randomized, controlled trial to test model predictive control for dosing erythropoietin in ESRD patients. The trial included 60 hemodialysis patients who were randomized into a treatment arm (30 subjects) that received erythropoietin doses on the basis of the computer recommendations or a control arm (30 subjects) that received erythropoietin doses on the basis of recommendations from a standard anemia management protocol (control). The subjects were followed for 8 months, and the proportions of measured Hb within the target of 11 to 12 g/dl and outside 9 to 13 g/dl were measured. Variability of the Hb level was measured by the absolute difference between the achieved Hb and the target Hb of 11.5 g/dl as well as the area under the Hb curve. RESULTS: Model predictive control resulted in 15 observations >13 or <9 g/dl (outliers), a mean absolute difference between achieved Hb and 11.5 g/dl of 0.98 +/- 0.08 g/dl, and an area under the Hb curve of 2.86 +/- 1.46. The control group algorithm resulted in 30 Hb outliers (P = 0.051), produced a mean absolute difference between achieved Hb and 11.5 g/dl of 1.18 +/- 0.18 g/dl (P < 0.001 difference in variance), and an area under the Hb curve of 3.38 +/- 2.69 (P = 0.025 difference in variance). CONCLUSIONS: Model predictive control of erythropoietin administration improves anemia management.
RCT Entities:
BACKGROUND AND OBJECTIVES: Variable hemoglobin (Hb) response to erythropoiesis stimulating agents may result in adverse outcomes. The utility of model predictive control for drug dosing was previously demonstrated. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a double-blinded, randomized, controlled trial to test model predictive control for dosing erythropoietin in ESRDpatients. The trial included 60 hemodialysis patients who were randomized into a treatment arm (30 subjects) that received erythropoietin doses on the basis of the computer recommendations or a control arm (30 subjects) that received erythropoietin doses on the basis of recommendations from a standard anemia management protocol (control). The subjects were followed for 8 months, and the proportions of measured Hb within the target of 11 to 12 g/dl and outside 9 to 13 g/dl were measured. Variability of the Hb level was measured by the absolute difference between the achieved Hb and the target Hb of 11.5 g/dl as well as the area under the Hb curve. RESULTS: Model predictive control resulted in 15 observations >13 or <9 g/dl (outliers), a mean absolute difference between achieved Hb and 11.5 g/dl of 0.98 +/- 0.08 g/dl, and an area under the Hb curve of 2.86 +/- 1.46. The control group algorithm resulted in 30 Hb outliers (P = 0.051), produced a mean absolute difference between achieved Hb and 11.5 g/dl of 1.18 +/- 0.18 g/dl (P < 0.001 difference in variance), and an area under the Hb curve of 3.38 +/- 2.69 (P = 0.025 difference in variance). CONCLUSIONS: Model predictive control of erythropoietin administration improves anemia management.
Authors: M Goicoechea; C Caramelo; P Rodriguez; E Verde; E Gruss; M Albalate; A Ortiz; S Casado; F Valderrábano Journal: Nephrol Dial Transplant Date: 2001-11 Impact factor: 5.992
Authors: Hossein Mirinejad; Adam E Gaweda; Michael E Brier; Jacek M Zurada; Tamer Inanc Journal: Comput Methods Programs Biomed Date: 2017-06-23 Impact factor: 5.428
Authors: Adam E Gaweda; George R Aronoff; Alfred A Jacobs; Shesh N Rai; Michael E Brier Journal: J Am Soc Nephrol Date: 2013-09-12 Impact factor: 10.121
Authors: Adam E Gaweda; Yelena Z Ginzburg; Yossi Chait; Michael J Germain; George R Aronoff; Eliezer Rachmilewitz Journal: Nephrol Dial Transplant Date: 2014-05-12 Impact factor: 5.992
Authors: Suetonia C Palmer; Valeria Saglimbene; Dimitris Mavridis; Georgia Salanti; Jonathan C Craig; Marcello Tonelli; Natasha Wiebe; Giovanni F M Strippoli Journal: Cochrane Database Syst Rev Date: 2014-12-08