Hossein Mirinejad1, Adam E Gaweda2, Michael E Brier3, Jacek M Zurada4, Tamer Inanc5. 1. Electrical and Computer Engineering Department, University of Louisville, Louisville, KY, USA. Electronic address: hmiri@umich.edu. 2. Department of Medicine, University of Louisville, Louisville, KY, USA. Electronic address: adam.gaweda@louisville.edu. 3. Department of Medicine, University of Louisville, Louisville, KY, USA; Department of Veteran Affairs, University of Louisville, Louisville, KY, USA. Electronic address: michael.brier@louisville.edu. 4. Electrical and Computer Engineering Department, University of Louisville, Louisville, KY, USA. Electronic address: jacek.zurada@louisville.edu. 5. Electrical and Computer Engineering Department, University of Louisville, Louisville, KY, USA. Electronic address: t.inanc@louisville.edu.
Abstract
BACKGROUND AND OBJECTIVE: Anemia is a common comorbidity in patients with chronic kidney disease (CKD) and is frequently associated with decreased physical component of quality of life, as well as adverse cardiovascular events. Current treatment methods for renal anemia are mostly population-based approaches treating individual patients with a one-size-fits-all model. However, FDA recommendations stipulate individualized anemia treatment with precise control of the hemoglobin concentration and minimal drug utilization. In accordance with these recommendations, this work presents an individualized drug dosing approach to anemia management by leveraging the theory of optimal control. METHODS: A Multiple Receding Horizon Control (MRHC) approach based on the RBF-Galerkin optimization method is proposed for individualized anemia management in CKD patients. Recently developed by the authors, the RBF-Galerkin method uses the radial basis function approximation along with the Galerkin error projection to solve constrained optimal control problems numerically. The proposed approach is applied to generate optimal dosing recommendations for individual patients. RESULTS: Performance of the proposed approach (MRHC) is compared in silico to that of a population-based anemia management protocol and an individualized multiple model predictive control method for two case scenarios: hemoglobin measurement with and without observational errors. In silico comparison indicates that hemoglobin concentration with MRHC method has less variation among the methods, especially in presence of measurement errors. In addition, the average achieved hemoglobin level from the MRHC is significantly closer to the target hemoglobin than that of the other two methods, according to the analysis of variance (ANOVA) statistical test. Furthermore, drug dosages recommended by the MRHC are more stable and accurate and reach the steady-state value notably faster than those generated by the other two methods. CONCLUSIONS: The proposed method is highly efficient for the control of hemoglobin level, yet provides accurate dosage adjustments in the treatment of CKD anemia.
BACKGROUND AND OBJECTIVE:Anemia is a common comorbidity in patients with chronic kidney disease (CKD) and is frequently associated with decreased physical component of quality of life, as well as adverse cardiovascular events. Current treatment methods for renal anemia are mostly population-based approaches treating individual patients with a one-size-fits-all model. However, FDA recommendations stipulate individualized anemia treatment with precise control of the hemoglobin concentration and minimal drug utilization. In accordance with these recommendations, this work presents an individualized drug dosing approach to anemia management by leveraging the theory of optimal control. METHODS: A Multiple Receding Horizon Control (MRHC) approach based on the RBF-Galerkin optimization method is proposed for individualized anemia management in CKDpatients. Recently developed by the authors, the RBF-Galerkin method uses the radial basis function approximation along with the Galerkin error projection to solve constrained optimal control problems numerically. The proposed approach is applied to generate optimal dosing recommendations for individual patients. RESULTS: Performance of the proposed approach (MRHC) is compared in silico to that of a population-based anemia management protocol and an individualized multiple model predictive control method for two case scenarios: hemoglobin measurement with and without observational errors. In silico comparison indicates that hemoglobin concentration with MRHC method has less variation among the methods, especially in presence of measurement errors. In addition, the average achieved hemoglobin level from the MRHC is significantly closer to the target hemoglobin than that of the other two methods, according to the analysis of variance (ANOVA) statistical test. Furthermore, drug dosages recommended by the MRHC are more stable and accurate and reach the steady-state value notably faster than those generated by the other two methods. CONCLUSIONS: The proposed method is highly efficient for the control of hemoglobin level, yet provides accurate dosage adjustments in the treatment of CKD anemia.
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: Elom Akabua; Tamer Inanc; Adam Gaweda; Michael E Brier; Seongho Kim; Jacek M Zurada Journal: Comput Methods Programs Biomed Date: 2014-10-14 Impact factor: 5.428
Authors: Michael E Brier; Adam E Gaweda; Andrew Dailey; George R Aronoff; Alfred A Jacobs Journal: Clin J Am Soc Nephrol Date: 2010-02-25 Impact factor: 8.237