Personalized Anemia Management and Precision Medicine in ESA and Iron Pharmacology in End-Stage Kidney Disease

Substantial progress has been made in the application of computer-driven methods to provide erythropoietic dosing information for patients with anemia resulting from chronic kidney disease. Initial solutions were simply computerized versions of traditional paper-based anemia management protocols. True personalization was achieved through the use of advanced modeling techniques such as artificial neural networks, physiologic models, and feedback control systems. The superiority of any one technique over another has not been determined, but all methods have shown an advantage in at least one area over the traditional paper expert system used by most dialysis facilities. Improvements in the percentage of hemoglobin measurements within target range, decreased within-subject hemoglobin variability, decreased erythropoiesis-stimulating agent dose, and decreased transfusion rates all have been shown.