title: Randomized trial of model predictive control for improved anemia management.
abstract: OBJECTIVE
  Variable hemoglobin (Hb) response to erythropoiesis stimulating agents may result in adverse outcomes. The utility of model predictive control for drug dosing was previously demonstrated.
  
  
  METHODS
  This was a double-blinded, randomized, controlled trial to test model predictive control for dosing erythropoietin in ESRD patients. The trial included 60 hemodialysis patients who were randomized into a treatment arm (30 subjects) that received erythropoietin doses on the basis of the computer recommendations or a control arm (30 subjects) that received erythropoietin doses on the basis of recommendations from a standard anemia management protocol (control). The subjects were followed for 8 months, and the proportions of measured Hb within the target of 11 to 12 g/dl and outside 9 to 13 g/dl were measured. Variability of the Hb level was measured by the absolute difference between the achieved Hb and the target Hb of 11.5 g/dl as well as the area under the Hb curve.
  
  
  RESULTS
  Model predictive control resulted in 15 observations >13 or <9 g/dl (outliers), a mean absolute difference between achieved Hb and 11.5 g/dl of 0.98 +/- 0.08 g/dl, and an area under the Hb curve of 2.86 +/- 1.46. The control group algorithm resulted in 30 Hb outliers (P = 0.051), produced a mean absolute difference between achieved Hb and 11.5 g/dl of 1.18 +/- 0.18 g/dl (P < 0.001 difference in variance), and an area under the Hb curve of 3.38 +/- 2.69 (P = 0.025 difference in variance).
  
  
  CONCLUSIONS
  Model predictive control of erythropoietin administration improves anemia management.
authors.affiliation: Department of Veterans Affairs, Louisville, Kentucky, USA. mbrier@louisville.edu
authors.forename: Michael E
authors.initials: ME
authors.lastname: Brier
authors.forename: Adam E
authors.initials: AE
authors.lastname: Gaweda
authors.forename: Andrew
authors.initials: A
authors.lastname: Dailey
authors.forename: George R
authors.initials: GR
authors.lastname: Aronoff
authors.forename: Alfred A
authors.initials: AA
authors.lastname: Jacobs
mesh_terms: D000368:Aged; D000465:Algorithms; D000740:Anemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D002985:Clinical Protocols; D004311:Double-Blind Method; D054796:Drug Dosage Calculations; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D006397:Hematinics / Q000008:administration & dosage*; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009722:Nurse Practitioners; D006435:Renal Dialysis / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006397:Hematinics; D006454:Hemoglobins; D004921:Erythropoietin