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Due to insufficient endogenous production of erythropoietin, chronic kidney disease patients with anemia are often treated by the administration of recombinant human erythropoietin (EPO). The target of the treatment is to keep the patient’s hemoglobin level within a normal range. While conventional methods for guiding EPO dosing used by clinicians normally rely on a set of rules based on past experiences or retrospective studies, model predictive control (MPC) based dosage optimization is receiving attention recently. The objective of this paper is to incorporate the hemoglobin response model uncertainty into the dosage optimization decision making. Two methods utilizing Conditional Value at Risk (CVaR) are proposed for hemoglobin control in chronic kidney disease under model uncertainty. The first method includes a set-point tracking controller with the addition of CVaR constraints. The second method involves the use of CVaR directly in the cost function of the optimal control problem. The methods are compared to set-point tracking MPC and Zone-tracking MPC through computer simulations. Simulation results demonstrate the benefits of utilizing CVaR in stochastic predictive control for EPO dosage optimization.

EPO Dosage Optimization for Anemia Management: Stochastic Control under Uncertainty Using Conditional Value at Risk