A European Delphi study on the management of anaemia of CKD: unmet needs in personalized treatment

Anaemia is a common complication of chronic kidney disease (CKD) impacting clinical outcomes and quality of life (QoL). Despite available treatment options, unmet needs exist, especially in relation to QoL. We aimed to develop a consensus of European nephrologists' opinion on the management of anaemia of CKD.

Seventy-six nephrologists from seven European countries participated in a modified Delphi panel, consisting of two survey rounds followed by an online consensus meeting. Consensus was defined as ≥ 80% agreement or disagreement. The responses were initially assessed against the KDIGO 2012 guideline and reassessed against the draft KDIGO 2025 guideline.

Panellists did not reach consensus on current guidelines being easy to implement or adequately considering patient needs, noting that updates are still needed. Patients with chronic inflammation, infection, erythropoiesis-stimulating agent (ESA) resistance, or cancer were identified as populations with unmet needs. Consensus was reached that patients should be more involved in decision-making regarding therapy options. Health-related QoL (HRQoL) was acknowledged as important in the management but no consensus was reached on the use of validated HRQoL tools.

European nephrologists believe that existing clinical practice guidelines are not sufficient for the management of patients with anaemia of CKD, especially in those with ESA hyporesponsiveness, infection, chronic inflammation, and malignancy. Unmet needs exist in personalized care, particularly with regard to involving patients and carers in clinical management decisions and using HRQoL tools in routine care. There are no substantial changes in the draft KDIGO 2025 guideline to adequately address the unmet needs identified here.