Development of best practice statements for anticoagulation in advanced kidney disease using the modified Delphi...

Area of Science:

• Nephrology
• Cardiology
• Hematology

Background:

• Patients with advanced kidney disease (eGFR < 30 mL/min/1.73 m2) face higher risks of blood clots and bleeding.
• Exclusion of these patients from clinical trials creates evidence gaps for anticoagulant use.
• This leads to variability in clinical practice regarding anticoagulation.

Purpose of the Study:

• To achieve expert consensus on anticoagulant use in advanced kidney disease.
• To inform the development of national prescribing guidance for this patient population.

Main Methods:

• A modified Delphi approach involving UK experts in cardiology, nephrology, and hematology.
• Three rounds of consensus-building, including questionnaires and online discussions.
• RAND methodology was used to define appropriateness and consensus.

Main Results:

• Consensus was reached on 72 statements for guideline inclusion.
• Key recommendations include dose reduction for therapeutic low molecular weight heparin (LMWH) and off-label apixaban use for non-valvular atrial fibrillation.
• Trough anti-Xa level monitoring for therapeutic LMWH was also agreed upon.

Conclusions:

• Expert consensus was achieved on critical aspects of anticoagulant use in advanced kidney disease.
• These consensus statements provide a foundation for national prescribing guidance in the UK.
• Further research recommendations can be developed from areas of consensus and disagreement.