title: Simplification of an erythropoiesis model for design of anemia management protocols in end stage renal disease.
abstract: Many end stage renal disease (ESRD) patients suffer from anemia due to insufficient endogenous production of erythropoietin (EPO). The discovery of recombinant human EPO (rHuEPO) over 30 years ago has shifted the treatment of anemia for patients on dialysis from blood transfusions to rHuEPO therapy. Many anemia management protocols (AMPs) used by clinicians comprise a set of experience-based rules for weekly-to-monthly titration of rHuEPO doses based on hemoglobin (Hgb) measurements. In order to facilitate the design of an AMP based on formal control design methods, we present a physiologically-relevant erythropoiesis model, and show that its nonlinear dynamics can be approximated using a static nonlinearity, a step that greatly simplifies AMP design. We demonstrate applicability of our results using clinical data.
authors.affiliation: Departments, UMass, Amherst, MA 01003, USA.
authors.forename: B
authors.initials: B
authors.lastname: Nichols
authors.forename: R P
authors.initials: RP
authors.lastname: Shrestha
authors.forename: J
authors.initials: J
authors.lastname: Horowitz
authors.forename: C V
authors.initials: CV
authors.lastname: Hollot
authors.forename: M J
authors.initials: MJ
authors.lastname: Germain
authors.forename: A E
authors.initials: AE
authors.lastname: Gaweda
authors.forename: Y
authors.initials: Y
authors.lastname: Chait
mesh_terms: D000740:Anemia / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism*; D003198:Computer Simulation; D004360:Drug Therapy, Computer-Assisted / Q000379:methods*; D004920:Erythropoiesis / Q000187:drug effects*; D004921:Erythropoietin / Q000008:administration & dosage* / Q000378:metabolism; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism*; D008954:Models, Biological; D016896:Treatment Outcome
chemical_list: C554270:EPO protein, human; D006454:Hemoglobins; D004921:Erythropoietin