Servicio de Nefrología, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Segovia de Arana IDIPHIM, Madrid, Spain.
Unidad de Nefrología, Hospital Universitario Reina Sofia, Instituto Maimónides de Investigación Biomédica IMIBIC, Universidad de Córdoba, Spain.
Nefrologia (Engl Ed). 2023 Sep-Oct;43(5):517-530. doi: 10.1016/j.nefroe.2023.10.005. Epub 2023 Nov 21.
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.
贫血是慢性肾脏病（CKD）的常见并发症，与生活质量下降、输血风险增加、发病率和死亡率增加以及 CKD 进展有关。西班牙肾脏病学会贫血工作组在 CKD 贫血专家中进行了一项 Delphi 研究，以根据现有证据就相关未解决的问题达成一致。采用了 RAND/UCLA 共识方法。我们定义了 15 个具有 PICO 结构的问题，然后在科学文献数据库中进行了回顾。根据文献综述为每个问题制定了陈述。19 名专家使用迭代式两轮 Delphi 样过程对其进行了评估。对 8 个与铁缺乏和铁（Fe）补充相关的问题（有无贫血时铁缺乏的影响和管理、铁缺乏标志物、静脉内铁的安全性）以及 7 个与促红细胞生成刺激剂（ESA）和/或缺氧诱导因子稳定剂（HIF）相关的问题做出了 16 项一致的回应，对所有问题都达成了共识（Hb 目标的个体化、ESA 抵抗的影响和管理、移植后即刻的 ESA 和 HIF 稳定剂：对铁动力学的影响、与炎症的相互作用和心血管安全性）。需要进行临床研究，以评估独立于贫血纠正铁缺乏的效果，以及各种 ESA 治疗贫血对生活质量、CKD 进展和心血管事件的影响。
