Unresolved aspects in the management of renal anemia, a Delphi consensus of the Anemia Group of the S.E.N.
Study Goal
The researchers aimed to evaluate the impact and management of erythropoiesis-stimulating agents (ESAs) and hypoxia-inducible factor stabilizers (HIF) in chronic kidney disease (CKD) patients, focusing on individualized hemoglobin objectives, resistance to ESA, and cardiovascular safety.
Results Summary
The study reached consensus on 16 statements related to ESAs and HIF stabilizers, including individualized hemoglobin targets and management of ESA resistance. However, it highlighted the need for further clinical studies on the effects of anemia treatment with various ESAs on quality of life, CKD progression, and cardiovascular events.
Population
Chronic kidney disease (CKD) patients with anemia.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
iron supplementation with Fe | neutral | iron deficiency with or without anemia | patients with chronic kidney disease | - | impact and management | #1 |
i.v. iron | neutral | iron deficiency | patients with chronic kidney disease | - | safety | #2 |
erythropoiesis stimulating agents (ESAs) | neutral | anemia | patients with chronic kidney disease | - | individualization of the Hb objective | #3 |
erythropoiesis stimulating agents (ESAs) | neutral | resistance to ESA | patients with chronic kidney disease | - | impact and management | #4 |
erythropoiesis stimulating agents (ESAs) | neutral | anemia | patients in the immediate post-transplant period | - | use | #5 |
hypoxia-inducible factor stabilizers (HIF) | neutral | iron metabolism | patients with chronic kidney disease | - | impact on ferrokinetics | #6 |
hypoxia-inducible factor stabilizers (HIF) | neutral | inflammation | patients with chronic kidney disease | - | interaction | #7 |
hypoxia-inducible factor stabilizers (HIF) | neutral | cardiovascular events | patients with chronic kidney disease | - | cardiovascular safety | #8 |
correction of iron deficiency | neutral | iron deficiency independently of anemia | patients with chronic kidney disease | - | effects | #9 |
anemia treatment with various ESA | neutral | quality of life | patients with chronic kidney disease | - | impact | #10 |
anemia treatment with various ESA | neutral | progression of CKD | patients with chronic kidney disease | - | impact | #11 |
anemia treatment with various ESA | neutral | cardiovascular events | patients with chronic kidney disease | - | impact | #12 |
Anemia is a common complication of chronic kidney disease (CKD) and is associated with a decrease in quality of life and an increased risk of transfusions, morbidity and mortality, and progression of CKD. The Anemia Working Group of the Sociedad Española de Nefrología conducted a Delphi study among experts in anemia in CKD to agree on relevant unanswered questions by existing evidence. The RAND/UCLA consensus methodology was used. We defined 15 questions with a PICO structure, followed by a review in scientific literature databases. Statements to each question were developed based on that literature review. Nineteen experts evaluated them using an iterative Two-Round Delphi-like process. Sixteen statements were agreed in response to 8 questions related to iron deficiency and supplementation with Fe (impact and management of iron deficiency with or without anemia, iron deficiency markers, safety of i.v. iron) and 7 related to erythropoiesis stimulating agents (ESAs) and/or hypoxia-inducible factor stabilizers (HIF), reaching consensus on all of them (individualization of the Hb objective, impact and management of resistance to ESA, ESA in the immediate post-transplant period and HIF stabilizers: impact on ferrokinetics, interaction with inflammation and cardiovascular safety). There is a need for clinical studies addressing the effects of correction of iron deficiency independently of anemia and the impact of anemia treatment with various ESA on quality of life, progression of CKD and cardiovascular events.