Abstract: SA-PO253
Model Predictive Control (MPC) for Iron Dosing for the Management of Anemia
Session Information
- Anemia and Iron Metabolism: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 202 Anemia and Iron Metabolism: Clinical
Authors
- Brier, Michael E., University of Louisville, Louisville, Kentucky, United States
- Gaweda, Adam E., University of Louisville, Louisville, Kentucky, United States
- Jacobs, Alfred A., University of Louisville, Louisville, Kentucky, United States
- Nayak, Vibha S., University of Louisville, Louisville, Kentucky, United States
- Lederer, Eleanor D., University of Louisville; Robley Rex VA Medical Center, Louisville, Kentucky, United States
Background
Recent studies have shown that anemia management can be improved using computer based tools to determine the dose of an erythropoietic stimulating agent (ESA). We tested the hypothesis that similar improvements can be acheived for iron dosing.
Methods
A ferrokinetic model was developed based on published data from iron studies. The model predicts monthly change in TSat and Ferritin in response to a dose adjustment of iron sucrose. Using this model, a dose adjustment algorithm was designed using principles of Model Predictive Control. The dosing objective was to drive TSat to a physician-specified target value of 35 without exceeding an upper Ferritin threshold, also specified by the physician user. Ten subjects were enrolled into a pilot study to test the safety and efficacy of the proposed approach. Subjects will be followed for 6 months and have completed 3 months follow up.Iron dose, Tsat, ferritin and epoetin beta methoxy polyethylene glycol (ESA) doses are recorded.
Results
Results for the control period (M-2,M-1) and treatment period (M1,M2,M3) are shown in the table by month.Tsat values increased following the implementation of the MPC reaching the mid-pint of the target range at 3 months. Hb values also increased and ESA dose decreased over the same period.No recommended doses were over-ridden by the physicians monitoring the project.
Conclusion
MPC control of iron dosing can compliment the use of similar decision support tools used to dose ESA's. Optiimal anemia management would maximize the dose of ESA and Iron to achieve individualized patient care. These results demonstrate the potential of simultaneously determing ESA and Iron dose in the management of patients with anemia of chronic kidney disease.
| M-2 | M-1 | M1 | M2 | M3 | |
| Tsat (%) | 26±6 | 28±12 | 30±13 | 29±9 | 33±12 |
| Hb (mg/dL) | 11.8±1.7 | 11.4±2.0 | 11.0±2.1 | 11.3±1.5 | 11.7±2.1 |
| Iron Dose (mg/month) | 500 | 325±189 | 478±370 | 507±265 | 375±228 |
| ESA Dose (ug/month) | 22±47 | 42±52 | 37±53 | 27±38 | 8±18 |
Month(M)
Funding
- NIDDK Support