Sandro Mazzaferro1, Silvia D'Alonzo2, Massimo Morosetti3. 1. Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy. 2. Department of Medical and Surgical Sciences, Nephrology Unit, Fondazione Policlinico Universitario "A. Gemelli" Istituto Di Ricovero E Cura a Carattere Scientifico, Rome, Italy. 3. Nephrology Unit, Giovambattista Grassi Hospital, via Giancarlo Passeroni 28, 00122, Rome, Italy. massimo.morosetti@aslroma3.it.
Abstract
BACKGROUND: Anaemia and iron deficiency (ID) are common in chronic kidney disease (CKD) patients and related to outcomes. There is growing interest about the role of iron supplementation in CKD, particularly ferric carboxymaltose (FCM), also in relation to the use of erythropoiesis stimulating agents (ESAs). Despite a greater knowledge on ID management in patients receiving haemodialysis, a paucity of data exists about peritoneal dialysis (PD). Furthermore, the aim of this paper is to provide the results of a nationwide Italian survey about ID in PD using the Delphi method. METHODS: A list of 16 statements (48 items) was developed about four main topics: (1) approach to iron therapy in PD; (2) management experience about iron therapy in PD; (3) ESA and iron in PD; (4) pharmacoeconomic impact. Using the Delphi methodology, the survey was distributed online to 36 Italian nephrologists with expertise in PD, who rated their level of agreement with each item on a 5-point Likert scale. Consensus was predefined as more than 66% of the panel agreeing/disagreeing with any given statement. RESULTS: Twenty-five experts (70%) answered the survey. 35 items (73%) achieved a consensus (8 negative and 27 positive). In particular, the diagnosis of ID is widely known, but some doubts exist about how frequently test it. The use of I.V. iron seems to be routinary and can save money reducing the administration of ESAs. However, internal protocols are welcome. CONCLUSIONS: Expert PD nephrologists know well the problem of ID and feel the necessity of shared protocols to optimize the iron therapy and consequently the use of ESAs.
BACKGROUND: Anaemia and iron deficiency (ID) are common in chronic kidney disease (CKD) patients and related to outcomes. There is growing interest about the role of iron supplementation in CKD, particularly ferric carboxymaltose (FCM), also in relation to the use of erythropoiesis stimulating agents (ESAs). Despite a greater knowledge on ID management in patients receiving haemodialysis, a paucity of data exists about peritoneal dialysis (PD). Furthermore, the aim of this paper is to provide the results of a nationwide Italian survey about ID in PD using the Delphi method. METHODS: A list of 16 statements (48 items) was developed about four main topics: (1) approach to iron therapy in PD; (2) management experience about iron therapy in PD; (3) ESA and iron in PD; (4) pharmacoeconomic impact. Using the Delphi methodology, the survey was distributed online to 36 Italian nephrologists with expertise in PD, who rated their level of agreement with each item on a 5-point Likert scale. Consensus was predefined as more than 66% of the panel agreeing/disagreeing with any given statement. RESULTS: Twenty-five experts (70%) answered the survey. 35 items (73%) achieved a consensus (8 negative and 27 positive). In particular, the diagnosis of ID is widely known, but some doubts exist about how frequently test it. The use of I.V. iron seems to be routinary and can save money reducing the administration of ESAs. However, internal protocols are welcome. CONCLUSIONS: Expert PD nephrologists know well the problem of ID and feel the necessity of shared protocols to optimize the iron therapy and consequently the use of ESAs.
Authors: Francois Madore; Colin T White; Rob N Foley; Brendan J Barrett; Louise M Moist; Scott W Klarenbach; Bruce F Culleton; Marcello Tonelli; Braden J Manns Journal: Kidney Int Suppl Date: 2008-08 Impact factor: 10.545
Authors: Alan S Kliger; Robert N Foley; David S Goldfarb; Stuart L Goldstein; Kirsten Johansen; Ajay Singh; Lynda Szczech Journal: Am J Kidney Dis Date: 2013-07-25 Impact factor: 8.860
Authors: Jodie L Babitt; Michele F Eisenga; Volker H Haase; Abhijit V Kshirsagar; Adeera Levin; Francesco Locatelli; Jolanta Małyszko; Dorine W Swinkels; Der-Cherng Tarng; Michael Cheung; Michel Jadoul; Wolfgang C Winkelmayer; Tilman B Drüeke Journal: Kidney Int Date: 2021-04-08 Impact factor: 10.612
Authors: Jose Portolés-Pérez; Beatriz Durá-Gúrpide; José Luis Merino-Rivas; Leyre Martín-Rodriguez; Covadonga Hevia-Ojanguren; Victor Burguera-Vion; Claudia Yuste-Lozano; Luisa Sánchez-García; Jose Ramon Rodriguez-Palomares; Vicente Paraiso Journal: Clin Kidney J Date: 2019-11-22