背景:慢性肾脏病(CKD)影响全球约10%的人口,估计影响约50%的2型糖尿病患者和50%的心力衰竭患者。指南推荐的方法是使用疾病改善疗法进行管理,但现实世界的数据表明,处方率在实践中并没有反映这一点。
目的:使用改良的德尔菲法,就CKD患者的最佳管理达成跨专业共识。
方法:一个由内科专家组成的国际指导小组,内分泌学/糖尿病学,肾脏病学和初级保健医学在CKD管理方面制定了42项声明,包括识别和筛查,危险因素,整体管理,指导方针,跨专业对齐和教育。共识是通过在线调查通过协议确定的。
方法:调查分发给心脏病专家,肾脏病学家,11个国家的内分泌学家和初级保健医生。
方法:指导小组先验确定共识的阈值为75%。停止标准被定义为每个国家25份答复的目标(N=275),和4周的调查期。
结果:2022年12月收到274份回复,来自阿根廷的25份回复,澳大利亚,巴西,危地马拉,墨西哥,新加坡,韩国,台湾,泰国,土耳其和埃及的24份答复。从心脏病专家那里收到了53份回复,52来自肾病学家,55来自内分泌学家,114来自初级保健医生。37项陈述达成非常高的一致(≥90%),5项达成高度一致(≥75%和<90%)。在声明中可以看到角色之间的强烈一致性,和不同水平的经验(2-5年或5年以上),各国之间观察到一些差异。
结论:来自11个国家的医疗保健专业人员在CKD管理方面存在高度共识。基于这些强有力的协议,指导小组得出了12项主要建议,重点关注CKD的诊断和治疗.
BACKGROUND: Chronic kidney disease (CKD) affects around 10% of the global population and has been estimated to affect around 50% of individuals with type 2 diabetes and 50% of those with heart failure. The guideline-recommended approach is to manage with disease-modifying therapies, but real-world data suggest that prescribing rates do not reflect this in practice.
OBJECTIVE: To develop a cross-specialty consensus on optimal management of the patient with CKD using a modified Delphi method.
METHODS: An international steering group of experts specialising in internal medicine, endocrinology/diabetology, nephrology and primary care medicine developed 42 statements on aspects of CKD management including identification and screening, risk factors, holistic management, guidelines, cross-specialty alignment and education. Consensus was determined by agreement using an online survey.
METHODS: The survey was distributed to cardiologists, nephrologists, endocrinologists and primary care physicians across 11 countries.
METHODS: The threshold for consensus agreement was established a priori by the steering group at 75%. Stopping criteria were defined as a target of 25 responses from each country (N=275), and a 4-week survey period.
RESULTS: 274 responses were received in December 2022, 25 responses from Argentina, Australia, Brazil, Guatemala, Mexico, Singapore, South Korea, Taiwan, Thailand, Turkey and 24 responses from Egypt. 53 responses were received from cardiologists, 52 from nephrologists, 55 from endocrinologists and 114 from primary care physicians. 37 statements attained very high agreement (≥90%) and 5 attained high agreement (≥75% and <90%). Strong alignment between roles was seen across the statements, and different levels of experience (2-5 years or 5+ years), some variation was observed between countries.
CONCLUSIONS: There is a high degree of consensus regarding aspects of CKD management among healthcare professionals from 11 countries. Based on these strong levels of agreement, the steering group derived 12 key recommendations focused on diagnosis and management of CKD.