Model predictive control of erythropoietin administration in the anemia of ESRD
Model predictive control of erythropoietin administration in the anemia of ESRD
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DOI：
10.1053/j.ajkd.2007.10.003
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发表时间：
2008-01-01
影响因子：
13.2
通讯作者：
Brier, Michael E.
中科院分区：
文献类型：
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作者：
Gaweda, Adam E.;Jacobs, AlfredA.;Brier, Michael E.
背景：对红细胞生成刺激剂（ESA）的可变血红蛋白（Hb）反应可能导致不良结局。研究设计：（1）通过建立Hb对ESA反应的人工神经网络模型，建立模型预测控制（MPC）算法。(2)计算机模拟测试MPC与常规贫血管理方案（AMP）。(3)临床试验，以测试MPC。设置和参与者：MPC是从历史数据，从186长期血液透析患者在路易斯维尔大学，肯塔基州。模拟测试发生在从186名患者中随机抽样产生的60名假设患者中。该试验包括9名血液透析患者谁收到ESA剂量的基础上MPC的建议超过6 months.Predictor：通过MPC或AMP的手段管理。结果的利益：实现Hb水平和变异性测量的手段之间的差异实现Hb水平和目标Hb水平的11.5 g/dL和促红细胞生成素剂量。在试验中，在研究之间的相同受试者中比较Hb水平偏离目标的情况（6个月中的最后4个月使用MPC）和控制（研究期开始后立即给予AMP 4个月）。在模拟中，AMP达到的Hb水平为12.3 +/- 0.6 g/dL，MPC为11.6 +/- 0.4 g/dL（P < 0.001），AMP的平均SD为0.75 +/- 0.30 g/dL，MPC为0.60 +/- 0.21 g/dL AMP和MPC与目标值的平均绝对差分别为0.8 +/- 0.6 g/dL和0.3 +/- 0.3 g/dL（P < 0.001）。在试验中，AMP和MPC的Hb水平分别为11.9 +/- 1.1 g/dL和11.8 +/- 0.6 g/dL（P = 0.8），AMP的平均SD为0.86 +/- 0.60 g/dL，MPC为0.64 +/- 0.33 g/dL（P 0.4），AMP和MPC与目标值的平均绝对差异分别为1.19 +/- 0.79 g/dL和0.79 +/- 0.50 g/dL（P 0.02）。结论：ESA的MPC可改善贫血管理。
Background: Variable hemoglobin (Hb) response to erythropoiesis-stimulating agents (ESAs) may result in adverse outcomes. New methods are needed to determine the appropriate dose of ESA to maintain the target Hb level.Design: (1) Observational study to develop an algorithm for model predictive control (MPC) by using an artificial neural network model of Hb response to ESA. (2) Computer simulation to test MPC versus a conventional anemia management protocol (AMP). (3) Clinical trial to test MPC.Setting & Participants: The MPC was developed from historic data from 186 long-term hemodialysis patients at the University of Louisville, KY. Testing by simulation occurred in 60 hypothetical patients generated from random sampling of the 186 patients. The trial included 9 hemodialysis patients who received ESA doses based on MPC recommendations over 6 months.Predictor: Management by means of MPC or AMP.Outcome of Interest: Achieved Hb level and variability measured by means of the difference between achieved Hb level and target Hb level of 11.5 g/dL and erythropoietin dose. In the trial, Hb level deviation from target was compared in the same subjects between the study (last 4 of 6 months on MPC) and control (4 months on AMP immediately proceeding the study period) periods.Results: In simulation, achieved Hb levels were 12.3 +/- 0.6 g/dL for AMP and 11.6 +/- 0.4 g/dL for MPC (P < 0.001), mean SDs were 0.75 +/- 0.30 g/dL for AMP and 0.60 +/- 0.21 g/dL for MPC (P < 0.01), and mean absolute differences from target were 0.8 +/- 0.6 g/dL for AMP and 0.3 +/- 0.3 g/dL for MPC (P < 0.001). In the trial, achieved Hb levels were 11.9 +/- 1.1 g/dL for AMP and 11.8 +/- 0.6 g/dL for MPC (P = 0.8), mean SDs were 0.86 +/- 0.60 g/dL for AMP and 0.64 +/- 0.33 g/dL for MPC (P 0.4), and mean absolute differences from target were 1.19 +/- 0.79 g/dL for AMP and 0.79 +/- 0.50 g/dL for MPC (P 0.02).Conclusion: MPC of ESAs may result in improved anemia management.