Real-world use of pegylated erythropoietin in CKD-related anemia: an Indian modified Delphi consensus

Anemia is a common and clinically significant complication of chronic kidney disease (CKD), contributing to impaired quality of life, increased cardiovascular risk, and higher mortality. Although erythropoiesis-stimulating agents (ESAs) remain the cornerstone of anemia management, conventional short- and intermediate-acting ESAs are associated with frequent dosing requirements, treatment burden, and variability in haemoglobin (Hb) control. Methoxy polyethylene glycol epoetin beta (MPG-EPO; PegEPO), a long-acting ESA with an extended half-life, enables less frequent administration and may offer advantages in Hb stabilization, treatment adherence, and patient convenience. Despite evidence supporting its efficacy and safety, the utilization of PegEPO in India remains limited. To provide practical guidance for the use of PegEPO in Indian clinical practice, a panel of 12 experienced Indian nephrologists participated in a three round modified Delphi consensus process. A comprehensive review of the available literature informed the development of consensus statements covering key domains, including patient selection, treatment initiation and dose adjustment, iron management, conversion from other ESAs, Hb targets and monitoring, safety considerations, and economic aspects of therapy. Consensus was achieved through iterative rounds of expert evaluation and discussion. The expert panel agreed that PegEPO offers efficacy and safety comparable to conventional ESAs in patients with CKD-associated anemia while providing additional advantages such as reduced dosing frequency, improved Hb stability, and the potential to enhance treatment adherence. The panel also identified practical considerations for optimizing PegEPO use in both dialysis-dependent and non-dialysis-dependent CKD populations within the Indian healthcare setting. This modified Delphi consensus provides evidence-informed, expert-driven recommendations to support individualized and pragmatic use of PegEPO in routine clinical practice. However, these statements represent expert consensus and are not intended as clinical guidelines; therefore, they should be adapted based on individual patient context and local clinical practice.