ArticlePLoS computational biology2023
Mechanisms of hemoglobin cycling in anemia patients treated with erythropoiesis-stimulating agents.
Article in PLoS computational biology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 11 citations in OpenAlex.
- A deterministic large language model (LLM) framework for safe, protocol-adherent clinical decision support: application in hemodialysis anemia management (AnemiaCare HDs).Frontiers in artificial intelligence · 2025Article
- Usage of the Anemia Control Model Is Associated with Reduced Hospitalization Risk in Hemodialysis.Biomedicines · 2024Article
- Effects of Individualized Anemia Therapy on Hemoglobin Stability: A Randomized Controlled Pilot Trial in Patients on Hemodialysis.Clinical journal of the American Society of Nephrology : CJASN · 2024Article
- Tubular Endogenous Erythropoietin Protects Renal Function against Ischemic Reperfusion Injury.International journal of molecular sciences · 2024Article
- Progress in the Detection of Erythropoietin in Blood, Urine, and Tissue.Molecules (Basel, Switzerland) · 2023Review
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Patients with renal anemia are frequently treated with erythropoiesis-stimulating agents (ESAs), which are dynamically dosed in order to stabilize blood hemoglobin levels within a specified target range. During typical ESA treatments, a fraction of patients experience hemoglobin 'cycling' periods during which hemoglobin levels periodically over- and undershoot the target range. Here we report a specific mechanism of hemoglobin cycling, whereby cycles emerge from the patient's delayed physiological response to ESAs and concurrent ESA dose adjustments. We introduce a minimal theoretical model that can explain dynamic hallmarks of observed hemoglobin cycling events in clinical time series and elucidates how physiological factors (such as red blood cell lifespan and ESA responsiveness) and treatment-related factors (such as dosing schemes) affect cycling. These results show that in general, hemoglobin cycling cannot be attributed to patient physiology or ESA treatment alone but emerges through an interplay of both, with consequences for the design of ESA treatment strategies.
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Registered trials
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