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Unresolved aspects in the management of renal anemia, a Delphi consensus of the Anemia Group of the S.E.N.

Nefrologia
January 1, 2023
José Portolés et al. (8 authors)
Journal ArticleReviewHuman Study
Study Details

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

Extracted Claims (12)
InterventionDirectionEndpointPopulationDosageImpactClaim #
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
Abstract

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.

Medical Subject Headings (MeSH)
HumansDelphi TechniqueConsensusQuality of LifeRenal Insufficiency, ChronicAnemiaChronic DiseaseIron Deficiencies
Study Links
Quality Scores
SafetyNot Assessed
Efficacy75/10
Quality85/10
0
Research Impact Scores
APT Score0.05
Weight Score2.36
Normalized Score0.67