Abstract for: An Individualized ESA Dosing Regimen for Hemodialysis Patients To Stabilize Hemoglobin Levels in a Target Range

We previously reported on a modeling project designed to determine erythropoietic stimulating agent (ESA) dosing regimens for hemodialysis patients, (Rogers, Gallaher, and Hocum). There, we describe the stages of model development, is implementation, and the results obtained. Here, we revisit the project to describe the model structure, focusing on the empirical foundations of the formulations and parameters as found in biomedical and clinical literature. We describe the model behavior, its replication of the clinical issue at hand, and show how the model was used to develop superior policies. We then discuss how the new policies were implemented in the host organization, and present the results which accrued over time. After a discussion of the limitations and possible extensions to the model, we suggest how so-called “inside the skin” dynamic modeling could shape the future of individualized medicine.