Abstract: SA-PO218
Anemia Management in Hemodialysis Patients: How Much Better Can We Do?
Session Information
- Anemia and Iron Metabolism: Basic
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
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
- Fuertinger, Stefan, Ernst Strüngmann Institute (ESI) for Neuroscience in Cooperation with Max Planck Society, Frankfurt am Main, Germany
- Cherif, Alhaji, Renal Research Institute, New York, New York, United States
- Kotanko, Peter, Renal Research Institute, New York, New York, United States
- Volkwein, Stefan, University of Konstanz, Konstanz, Germany
Background
The goal of anemia management with erythropoiesis-stimulating agents (ESA) is to achieve target hemoglobin (Hgb) levels while keeping drug doses low. Built on a physiology-based mathematical model of erythropoiesis (Fuertinger et al., PLoS ONE 2018), we developed an optimal control algorithm for individualized methoxy polyethylene glycol-epoetin beta (Mircera®) dose optimization.
Methods
The designed algorithm is a model predictive controller (MPC) that aims to stabilize Hgb levels at 10.5 g/dl. We compared the MPC administration regimen to a standard treatment protocol (STP) in an in-silico study for 6,659 chronic hemodialysis (HD) patients over a period of one year. Based on the Hgb levels obtained by the protocol, the in-silico population was divided into Hgb cyclers (cycles with amplitude >1.5 g/dl and duration >8 weeks, at least two cycles per year) and non-cyclers as defined by Fishbane & Berns (Kidney Int., 2015) yielding 1,987 cyclers.
Results
For non-cyclers, the MPC and STP regimens produced similar outcomes with respect to achieving Hgb targets and ESA usage. However, for cyclers, the MPC outperformed the STP. Cyclers’ percentage of Hgb values within the target range of 10-11.5 g/dl for both treatment approaches are shown in Figure 1. The MPC lead to 91% of cyclers with at least 80% of Hgb values within the range and lowered the monthly Mircera® dose on average by 30%.
Conclusion
Our analysis shows a clear potential for better anemia management in Hgb cyclers as a subpopulation of HD patients: The MPC stabilized Hgb levels with a significantly reduced amount of Mircera® in this in-silico study. For non-cyclers, the STP could not be outperformed. Clinical studies are warranted to validate these findings.
Cyclers' percentage of Hgb values within the target range of 10-11.5 g/dl for the MPC and STP regimen.