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International Physicians Delphi Survey: Managing Patients With IgA Nephropathy

Journal article
Published on May 26, 2022

Topics: Nephrology IgAN RWE Survey

Contributors:
Floege J, Barratt J, Coppo R et al.
Name of Journal:
Kidney International Reports


View Publication
DOI:
10.1016/j.ekir.2022.05.022
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Home » Publications » Delphi Survey: Managing IgA Nephropathy

Summary

Nephrologists, both in North America and Europe, agree on treatment for patients with IgA nephropathy1

Background

IgA nephropathy is a chronic kidney disease (CKD), with 10% to 60% of patients with IgA nephropathy progressing to kidney failure within 10 years.2 Clinical practice guidelines for IgA nephropathy treatment are available, such as the Kidney Disease: Improving Global Outcomes (KDIGO) guideline for the management of glomerular diseases, but it is unclear to what extent nephrologists from around the world agree with and adhere to these guidelines.1,3


Aim

The aim of this Delphi Focal Segmental Glomerulosclerosis and IgA Nephropathy Experts (DEFINE): Physicians study was to capture nephrologists’ opinions and to gain consensus on statements describing IgA nephropathy treatment, monitoring, diagnosis, and pathophysiology.1,4


Approach

The participants of this international Delphi survey were adult and pediatric nephrologists from seven countries in North America and Europe who had experience diagnosing and treating patients with IgA nephropathy.1,4

The survey sought agreement with 20 statements about IgA nephropathy and was done in two rounds1:

  • In the first round, the participants scored all statements using a 1 to 9 Likert scale (1 = strongly disagree, 9 = strongly agree); agreement with a statement was defined as a rating between 7 and 91
  • Any statements not meeting criteria for high consensus in round 1, defined as ≥90% agreement among participants, were revised based on feedback from the participants and retested in a second round4
  • Most statements of the survey were in alignment with the 2021 KDIGO practice guidelines1

Findings

Statements reaching high consensus agreement

Almost all statements met the criteria for high consensus agreement in round 1 of the survey (19/20 [95%]).1 The highly agreed upon topics included1:

  • Proteinuria as a key factor for determining prognosis and treatment strategy
  • Use of angiotensin-converting enzyme inhibitors (ACEis) or angiotensin II receptor blockers (ARBs) as supporting therapy in patients with persistent proteinuria
  • Use of corticosteroids in pediatric patients with IgA nephropathy
  • Treatment of severe or rapidly progressive disease with corticosteroids and cyclophosphamide when appropriate

Statements of moderate consensus

Only one statement did not reach high consensus in the first round, but rather met the criteria for moderate consensus, defined as 75% to 89% agreement.1

This statement was regarding short-term use of corticosteroids in adult patients with IgA nephropathy with high levels of proteinuria despite optimized renin-angiotensin system inhibitor (RASi) therapy.1 For round 2, the statement was split in two, but both parts remained at a moderate consensus level.1

Comparing North American and European responses

Most statements reached similar levels of agreement between both groups the exception being the statement on corticosteroid use in adults (North America: 95% agreement; Europe: 82% agreement [P=0.011]).1


Key takeway

Nephrologists from both North America and Europe have similar views on IgA nephropathy treatment, with their opinions largely aligning with KDIGO guidelines.1 Proteinuria is seen as an important prognostic marker, and nephrologists agree on proteinuria reduction being key to preserving kidney function.1 Some disagreement was found around use of corticosteroids, suggesting that further research on the risk-benefit profile of corticosteroids are needed.1




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Footnotes

ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; CKD, chronic kidney disease; DEFINE, Delphi Focal Segmental Glomerulosclerosis and IgA Nephropathy Experts; IgA, immunoglobulin A; KDIGO, Kidney Disease: Improving Global Outcomes; RASi, renin-angiotensin system inhibitor.

  1. Floege J et al. Kidney Int Rep. 2022;7(9):2076-2080.
  2. Barbour S, Feehally J. Curr Opin Nephrol Hypertens. 2017;26:319-326.
  3. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. Kidney Int. 2021;100(4S):S1-S276.
  4. Floege J et al. Kidney Int Rep. 2022;7(9):2076-2080. Supplemental Materials.

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