Mechanical and Industrial Engineering Department, University of Massachusetts, Amherst, MA, 01003, USA.
Renal and Transplant Associates of New England, PC, Springfield, MA, 01107, USA.
Ann Biomed Eng. 2021 Jan;49(1):171-179. doi: 10.1007/s10439-020-02520-1. Epub 2020 May 7.
The optimal use of erythropoiesis stimulating agents to treat anemia of end-stage renal disease remains difficult due to reported associations with adverse events. A patient's hemoglobin response to these agents cannot be accurately described using population-level models due to many individual factors including chronic inflammation, red blood cell lifespan, and acute blood loss. As a consequence, it is generally understood that current one-size-fits-all anemia management protocols result in suboptimal outcomes. In this paper, we report on our collaboration with the medical community in designing anemia management protocols. In clinical implementation, these new dosing protocols have led to improved outcomes due to their use of control-relevant modelling, model parameter identification, and principles of feedback control. This is an example of medical professionals and control engineers working together to positively affect the performance of anemia management protocols in end-stage renal disease.
由于报告的不良事件相关，最佳利用红细胞生成刺激剂治疗终末期肾病的贫血仍然很困难。由于许多个体因素，包括慢性炎症、红细胞寿命和急性失血，这些药物对患者血红蛋白的反应无法通过基于人群的模型准确描述。因此，通常认为目前一刀切的贫血管理方案会导致不理想的结果。在本文中，我们报告了与医学界合作设计贫血管理方案的情况。在临床实施中，由于这些新的剂量方案使用了控制相关建模、模型参数识别和反馈控制原则，因此改善了治疗效果。这是医学专业人员和控制工程师共同努力，积极影响终末期肾病贫血管理方案性能的一个例子。
