Real World Use of Pegylated Erythropoietin in CKD Anemia: An Indian Modified Delphi Consensus

Background Anemia is a common complication in chronic kidney disease (CKD) and is associated with adverse outcomes particularly in the advanced stage. Iron therapy and Erythropoesis stimulating agents (ESAs) form the cornerstone of its management. Among ESAs, there are various options available for usage, however each one differs in its structure and frequency of administration. Pegylated erythropoietin is having the longest half life, and is available for usage in renal anemia in India for long time but somewhat is less utilized in therapy. This consensus was done to generate expert consensus from practising Nephrologists from India regarding pegylated erythropoietin utility in CKD induced anemia Methods Using a modified Delphi methodology, an expert panel underwent three rounds of survey and came up with the expert consensus. Responses were recorded using 5- point Likert scale. Results A total of 35 consensus statements were generated, 12/35 (100%) had unanimous agreement, 9/35 had > 90% agreement and rest of them were above the predefined threshold of > 75%. Conclusions Pegylated erythropoietin, being the longest acting ESA has certain advantages like longer half life, lesser Hb fluctuations and lesser pricks, has shown to be non inferior to other ESAs in various phase 3 and real world studies. The consensus statement in this study will guide the nephrologists regarding usage of pegylated erythropoietin in renal anemia and its placement in the therapy.