Artificial Intelligence for Optimal Anemia Management in End-stage Renal Disease: The Anemia Control Model (ACM) Trial

Fresenius Medical Care has developed a computer software programme called the Anaemia Control Management (ACM) software to assist in the anaemia management of patients with chronic kidney disease (CKD) undergoing hemodialysis. This trial is designed to assess the effectiveness of this ACM software on anaemia management in routine clinical practice. However, all ultimate decisions on therapeutic or diagnostic procedures, treatments, management of the disease, or resource utilisation will be at the discretion of the Investigator. The trial consists of a retrospective (historical) control period and a prospective (going forward) period. During the prospective period, the ACM will be used to assist the Investigators' decision making and will help the Investigators to administer a personalised intravenous (IV) iron and red blood cell stimulating agent (ESA) therapy, whereas treatment according to standard of care will be documented retrospectively for the same patients during the retrospective period of the trial. Thus, patients can serve as their own control.

Fresenius Medical Care has developed an algorithm that uses a data-driven computational intelligence model based on an artificial neural network architecture (ACM) to generate individualised ESA dose recommendations from a history of dose and response information and specific patient demographic characteristics.

The ACM has been validated and complies with the European requirements for medical devices. The ACM was classified as a Class I medical device in accordance with Directive 93/42/EEC. A proof of concept trial was conducted in 3 NephroCare dialysis clinics (managed by Fresenius) in the Czech Republic, Portugal, and Spain. It could be shown that the introduction of ACM-guided therapy led to a significant decrease in median darbepoetin doses and to a significant increase in on-target haemoglobin (Hb) values along with a decrease in Hb fluctuation. Moreover, a retrospective trial conducted in NephroCare clinics in Portugal, suggested that ACM is able to reliably predict the long-term response to ESA and iron therapy in patients undergoing haemodialysis.

The current trial will test the applicability of the ACM outside of Fresenius clinics in a public hospital setting in the UK. Both intravenous (IV) iron and ESA doses will be recommended by the algorithm. The effectiveness of ACM-guided therapy on several anaemia outcomes will be assessed in adult patients with End Stage Renal Disease (ESRD).This trial will be conducted at 1 main unit and 5 satellite units at King's College Hospital, London, UK, in patients with ESRD who are routinely undergoing haemodialysis.

This trial is designed to assess the effectiveness of the ACM software on anaemia management in routine clinical practice. However, all ultimate decisions on therapeutic or diagnostic procedures, treatments, management of the disease, or resource utilisation will be at the discretion of the Investigator.

The trial will consist of a retrospective control period and a prospective period. During the prospective period, the ACM will be used to facilitate the Investigators' decision making and will help the Investigators to administer a personalised IV iron and ESA therapy, whereas treatment according to standard of care will be documented retrospectively for the same patients during the retrospective period of the trial. Thus, patients can serve as their own control.

The planned overall duration of the trial is 18 months (12 months recruitment period + 6 months until last patient last visit). The planned duration of prospective treatment for an individual patient will be 6 months. The collection of retrospective data from medical records covering a period of 6 months will take place as soon as the Informed Consent Form (ICF) is signed but at the latest at baseline.

Data will be collected at designated time Points (monthly) throughout the Trial once the ICF is signed: at the latest at baseline (collection of retrospective data), at baseline (start of prospective documentation), and for the observation time points (Month 1 to Month 6). However, examinations will follow routine clinical practice at the site according to the Investigator's decision.

Eligibility Criteria:
Inclusion Criteria:

* Age 19 to 90 years
* On haemodialysis for the past 18 months prior to baseline
* Treatment with IV iron sucrose during the past 6 months according to the respective Summary of Product Characteristics (SmPC)
* Treatment with epoetin beta during the past 6 months according to the respective SmPC
* Regular Hb measurements and at least 5 (standard of care, approximately monthly) Hb measurements during the past 6 months
* Ferritin measurements during the past 6 months (at least 2 measurements)
* Signed informed consent

Exclusion Criteria:

* Life expectancy \<6 months
* One or more Hb measurements \<8 g/dl during the control period
* Living-donor transplant scheduled within the next 6 months
* Scheduled for switch to peritoneal dialysis or home haemodialysis
* Blood transfusion during the past 9 months
* Pregnancy or breast feeding
* Active infection
* Current malignancy or haematological disorder
* Previous severe hypersensitivity reaction to IV iron sucrose
* Serious allergic reactions to darbepoetin alfa or epoetin alfa/beta/zeta, respectively
* Current treatment with PEGylated erythropoietin
* Surgery in the past 6 months
* Surgery scheduled within the next 6 months
* Participation in a clinical trial in the past 7 months