Abstract: FR-PO984

Engineering-Based Individualized Anemia Management in Hemodialysis Patients

Session Information

Category: Bioengineering and Informatics

  • 101 Bioengineering and Informatics

Authors

  • Alexander, Biro, WOLFSON MEDICAL CENTER, HOLON, Israel
  • Blumberg Benyamini, Sara, Wolfson Medical Center, Holon, Israel
  • Germain, Michael J., Renal and Transplant Assoc of New England, Hampden, Massachusetts, United States
  • Horowitz, Joseph, University of Massachusetts, Amherst, Massachusetts, United States
  • Barnea, Zvi, Wolfson Medical Center, Holon, Israel, Holon, Israel
  • Cernes, Relu, WOLFSON MEDICAL CENTER, HOLON,ISRAEL, HOLON, Israel
  • Chait, Yossi, University of Massachusetts, Amherst, Massachusetts, United States
  • Rachmilewitz, Eliezer, Wolfson Medical Center, Holon, Israel
  • Katzir, Ze'ev, Institute of Nephrology, Holon, Israel
Background

Management of erythropoietin stimulating agents and parenteral iron in hemodialysis (HD) patients is performed according to protocols derived from population response data. This pilot study examined whether individualized dosing can reduce hemoglobin (Hb) variability and increase the proportion of Hb levels within range compared with standard protocol results, while transferrin saturation (TSAT) and Ferritin levels would remain similar, and that the use of medications could be reduced.

Methods

We enrolled 25 maintenance HD patients treated using a bi-weekly titration and dosing protocol. We switched into a computerized, individualized protocol based on feedback principles and a mathematical model [1]; The ESA protocol has been validated in prior studies while the IV Iron protocol was newly derived. In the individualized protocol dosing schedule was switched to weekly. Target and range Hb were 11.5 and (11,12) g/dl, respectively. Results are reported from the first 9 months of the year-long, crossover study with 3-month washout period; Hb variability measure was the standard deviation (sd). Baseline refers to the 6-month period prior to the study, and Study refers to the most recent 6-month. For normal data we used the t-test to compare means and Pitman’s test for sds; medians of nonnormal data were compared by the signed rank test; and McNemar’s test was used for binary data. and statistical significance is defined as P-value < 0.05.

Results

(Table)

Conclusion

The individualized anemia protocol has improved %Hb in range and reduced Hb variability compared with standard protocol, while Aranesp and Venofer doses were reduced. However, TSAT and Ferritin levels decreased suggesting that our Iron IV algorithm may require modification.

1. Chait Y, Horowitz J, Nichols B, Shrestha RP, Hollot CV, Germain MJ. Control-relevant erythropoiesis modeling in end-stage renal disease. IEEE Trans Biomed Eng. 2014

ParameterBaselineStudyP-value
Hb, mean (g/dL)11.611.30.113
Hb, sd (g/dl)0.950.530.003
Hb in range (%)50680.124
TSAT, mean (sd)28.9 (7.5)22.6 (5.7)<0.0001
Ferritin, median [IQR] (ng/ml)504 [405,725]467 [310,638]0.024
Aranesp, median [IQR] (mg/month)184 [108,267]115 [85,255]0.027
Venofer, median [IQR] (mg/month)200 [100,317]154 [75,192]0.062

Funding

  • NIDDK Support