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Abstract: TH-PO229

Effects of Dosing Frequency on the Efficiency of EPO Administration in Hemodialysis Patients

Session Information

Category: Anemia and Iron Metabolism

  • 201 Anemia and Iron Metabolism: Basic

Authors

  • Rogg, Sabrina, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
  • Fuertinger, Doris H., Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
  • Volkwein, Stefan, University of Konstanz, Konstanz, Germany
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
Background

Achieving target hemoglobin (Hgb) levels in hemodialysis (HD) patients treated with short-acting erythropoietin (EPO) is challenging. It is highly desirable to keep drug doses low to mitigate adverse events and to reduce costs. Based on a mathematical model of erythropoiesis we developed a model predictive control (MPC) algorithm for patient-level EPO dose optimization.

Methods

Using an individualized model of erythropoiesis (Fuertinger et al, PLoS ONE 2018) an MPC algorithm is designed for computation of EPO doses at predefined dosing frequencies. The MPC aims to stabilize Hgb levels at 10.5 g/dl. Hgb variability and total amount of administered EPO are compared in an in-silico study in 60 chronic HD patients over a period of 150 days for a thrice weekly versus a daily EPO administration regimen.

Results

Daily and thrice weekly administration maintain Hgb levels equally within the target Hgb range of 10-12 g/dl except one patient reaching the target range only via daily administration. Compared to thrice weekly EPO administration, the daily administration scheme reduces Hgb variability by 8.9% and lowers the cumulative EPO dose by 18.1%. Figure 1 shows the results obtained in a single patient.

Conclusion

Our analysis shows a clear potential for reducing the risk of adverse events and saving costs by increasing the EPO dosing frequency and thereby reducing the required amount of EPO to correct the patient’s anemia. Clinical studies are warranted to validate these findings.