Chiodini Iacopo, d'Angela Daniela, Falchetti Alberto, Gennari Luigi, Malavolta Nazzarena, Masi Laura, Migliore Antonio, Orso Massimiliano, Polistena Barbara, Rendina Domenico, Scillitani Alfredo, Spandonaro Federico, Vezzoli Giuseppe, Vescini Fabio
Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, 20100, Italy.
Unit of Endocrinology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
J Endocrinol Invest. 2025 Feb;48(2):257-267. doi: 10.1007/s40618-024-02458-4. Epub 2024 Oct 8.
The study aimed to present the results of a Delphi consensus involving Italian experts focusing on the management of hypophosphatemia in adults.
A multidisciplinary advisory board of nine physicians, experts in hypophosphatemia management, was established. Next, a literature search was performed to identify international guidelines, consensus, and clinical pathways, which were later presented to the advisory board. Collaboratively, the advisory board and authoring team selected key statements for the consensus process and focused on areas of uncertainty related to the management of hypophosphatemia. The advisory board also indicated the experts to be invited to participate in the consensus process. The Delphi method was employed to reach a consensus.
The literature search yielded one guideline, five consensus documents, and one clinical pathway. While our search strategy aimed to identify documents on the management of all types of hypophosphatemia, most of the guidelines and consensus documents retrieved focused on X-linked hypophosphatemia. The consensus process focused on 11 key issues, achieving strong convergence (over 70% consensus) in the first Delphi round for 8 out of the 11 statements. Three statements proceeded to the second round, with strong agreement reached for two. Notably, consensus was not reached for the statement concerning the measurement of fibroblast growth factor 23 for diagnostic purposes.
The study revealed that the community of clinical experts is well-informed and in agreement regarding hypophosphatemia management. It emphasized the importance of developing clear national guidance documents to support clinicians and multidisciplinary teams in patient management. These documents are crucial not only for healthcare professionals but also for those responsible for defining pathways and services, facilitating a more accurate management of hypophosphatemic patients.
本研究旨在呈现一项涉及意大利专家的德尔菲共识结果，该共识聚焦于成人低磷血症的管理。
成立了一个由九名低磷血症管理专家医师组成的多学科咨询委员会。接下来，进行了文献检索以确定国际指南、共识和临床路径，随后将其提交给咨询委员会。咨询委员会和撰写团队共同为共识过程选择关键陈述，并聚焦于与低磷血症管理相关的不确定性领域。咨询委员会还指定了受邀参与共识过程的专家。采用德尔菲法达成共识。
文献检索产生了一份指南、五份共识文件和一条临床路径。虽然我们的检索策略旨在识别关于所有类型低磷血症管理的文件，但检索到的大多数指南和共识文件都聚焦于X连锁低磷血症。共识过程聚焦于11个关键问题，在第一轮德尔菲调查中，11项陈述中有8项达成了强烈共识（超过70%的共识）。三项陈述进入第二轮，其中两项达成了强烈共识。值得注意的是，关于用于诊断目的的成纤维细胞生长因子23测量的陈述未达成共识。
该研究表明，临床专家群体对低磷血症管理有充分了解且意见一致。它强调了制定明确的国家指导文件以支持临床医生和多学科团队进行患者管理的重要性。这些文件不仅对医疗保健专业人员至关重要，而且对负责确定路径和服务的人员也至关重要，有助于更准确地管理低磷血症患者。
