Assessment of an Anemia Model Predictive Controller for Anemia Management in Hemodialysis Patients

NCT ID: NCT04360902

Last Updated: 2020-04-24

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 60 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2020-01-08
• Study Completion Date: 2021-12-31

Brief Summary

The purpose of this randomized, controlled pilot study is to evaluate the performance of this novel Anemia Controller (vis-à-vis standard of care) for anemia management in hemodialysis patients. Since the Anemia Controller is designed to bring patients to a pre-defined Hgb target level and keep them there, the target population for this study are patients whose Hgb levels are currently not well-controlled (rather than patients who are already relatively stable within the Hgb target range under a standard anemia management algorithm). Specifically, therefore, the target population for this clinical study are chronic hemodialysis patients who are exhibiting Hgb cycling.

Conditions

End Stage Renal Disease; Renal Anemia; Chronic Kidney Diseases

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: SUPPORTIVE_CARE
• Blinding Strategy: NONE

Study Groups

Standard of Care Group

Subjects in the standard of care group will continue to receive anemia management in the same way they normally do as part of their routine dialysis care. For the purposes of this study, this means the use of the clinic's established Mircera® anemia management algorithm. Participation in this study will not affect the anemia management of subjects in the control group.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Intervention Group

For subjects randomized into the intervention group, our erythropoiesis model will be used to identify each subject's individual values for several physiological determinants of erythropoiesis based on his/her sex, body height and history of body weights, Hgb concentrations and Mircera® administrations over the preceding 150 to 180 days.

For subjects in the intervention group, their current method of anemia management will be discontinued. From this point on, Mircera® dose recommendations will be generated by the Anemia Controller software based on our erythropoiesis model and each subject for the duration of their 26-week participation in this study. The Anemia Controller computes the Mircera® doses required to attain the target Hgb level of 10.5 g/dL. Controller-generated Mircera® recommendations will be communicated to the respective clinics' anemia managers on a standardized report.

Group Type: EXPERIMENTAL

Anemia Controller

Intervention Type: OTHER

Model Predictive Controller software (called "Anemia Controller") that utilizes our physiology-based erythropoiesis model to provide ESA dosing recommendations in order to guide a patient's Hgb level towards a predefined target value.

Interventions

Anemia Controller

Model Predictive Controller software (called "Anemia Controller") that utilizes our physiology-based erythropoiesis model to provide ESA dosing recommendations in order to guide a patient's Hgb level towards a predefined target value.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Age ≥18 years
• Ability to give written informed consent to the study
• End-stage renal disease treated with thrice-weekly hemodialysis for at least 180 days preceding enrollment
• Receiving intradialytic Crit-Line® monitoring, with available Crit-Line® data going back at least 180 days from the date of enrollment
• Laboratory Hgb data going back at least 180 days from the date of enrollment
• On average, Hgb values available from at least 2 treatments per week (from either source, Crit-Line® or laboratory) during the past 180 days preceding enrollment
• Renal anemia treated with intravenous Mircera®, with at least 2 Mircera® dose administrations during the 150 days preceding enrollment
• On an active Mircera® anemia management algorithm order during the 180 days preceding enrollment
• Exclusively on Mircera® (no other ESAs) during the 180 days preceding enrollment
• Pattern of Hgb cycling as defined above during the 180 days preceding enrollment

Exclusion Criteria

• Having received the maximum Mircera® dose (225 µg every other week) consistently throughout the 90 days preceding enrollment
• Hospitalization for more than 10 days during the 30 days preceding enrollment
• Severe iron deficiency (TSAT <20%, ferritin <100 ng/mL) in the most recent routine blood work prior to enrollment
• Any known cause of ESA resistance other than iron deficiency and inflammatory states (e.g. hematologic malignancies, hypersplenism, antibody mediated pure red cell aplasia)
• Simultaneous participation in another clinical study that may impact anemia management or the outcomes of this trial
• Inability to communicate in English or Spanish

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Renal Research Institute

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

RRI

New York, New York, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Manager, RRI Program

Role: CONTACT

sherline.pereira@rriny.com

212-331-1700

Facility Contacts

Manager, Renal Research Programs

Role: primary

References

Fuertinger DH, Wang LC, Jorg DJ, Rivera Fuentes L, Ye X, Casper S, Zhang H, Mermelstein A, Cherif A, Ho K, Raimann JG, Tisdale L, Kotanko P, Thijssen S. Effects of Individualized Anemia Therapy on Hemoglobin Stability: A Randomized Controlled Pilot Trial in Patients on Hemodialysis. Clin J Am Soc Nephrol. 2024 Sep 1;19(9):1138-1147. doi: 10.2215/CJN.0000000000000488. Epub 2024 Jun 11.

Reference Type: DERIVED

PMID: 38861324 (View on PubMed)

Other Identifiers

RRI-19-003

Identifier Type: -

Identifier Source: org_study_id