Academic Journal
Development of best practice statements for anticoagulation in advanced kidney disease using the modified Delphi method.
| Τίτλος: | Development of best practice statements for anticoagulation in advanced kidney disease using the modified Delphi method. |
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| Συγγραφείς: | Parker K; Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom.; Division of Pharmacy and Optometry, University of Manchester, Manchester, United Kingdom., Hartemink J; Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom.; School of Medical Sciences, University of Manchester, Manchester, United Kingdom., Choudhuri S; Department of Haematology, Royal Oldham Hospital, Northern Care Alliance, Oldham,United Kingdom., Power A; Department of Nephrology, North Bristol NHS Foundation Trust, Bristol, United Kingdom., Tsang JY; Bodey Medical Practice and Centre for Primary Care, Manchester, United Kingdom.; Health Services Research, School of Health Sciences, the University of Manchester, Manchester, United Kingdom., Thachil J; School of Medical Sciences, University of Manchester, Manchester, United Kingdom.; Department of Haematology, Manchester University NHS Foundation Trust, Manchester, United Kingdom., Mitra S; Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom.; School of Medical Sciences, University of Manchester, Manchester, United Kingdom., Lewis P; Division of Pharmacy and Optometry, University of Manchester, Manchester, United Kingdom. |
| Πηγή: | Journal of nephrology [J Nephrol] 2026 Oct 10; Vol. 39 (6), pp. 1238-1245. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Springer Country of Publication: England NLM ID: 9012268 Publication Model: Print Cited Medium: Internet ISSN: 1724-6059 (Electronic) Linking ISSN: 11218428 NLM ISO Abbreviation: J Nephrol Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2014- : Heidelberg : Springer Original Publication: Rome : Acta Medica |
| Ιατρικοί όροι (MeSH): | Anticoagulants*/adverse effects , Anticoagulants*/administration & dosage , Anticoagulants*/therapeutic use , Atrial Fibrillation*/drug therapy , Venous Thromboembolism*/prevention & control , Venous Thromboembolism*/etiology , Practice Guidelines as Topic*, Heparin, Low-Molecular-Weight/administration & dosage ; Heparin, Low-Molecular-Weight/adverse effects ; Hemorrhage/chemically induced ; Pyridones/administration & dosage ; Pyridones/adverse effects ; Pyrazoles/administration & dosage ; Pyrazoles/adverse effects ; Humans ; Delphi Technique ; Consensus ; Glomerular Filtration Rate |
| Περίληψη: | Background: Patients with advanced kidney disease (estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m2) are known to have an increased risk of venous thromboembolic events and increased likelihood of atrial fibrillation alongside an increased risk of bleeding. People with advanced kidney disease are often excluded from randomised controlled trials (RCTs) of anticoagulants, leaving gaps in the evidence base and practice variation. This study aimed to achieve consensus on anticoagulant use in advanced kidney disease to inform national prescribing guidance. Methods: A modified Delphi approach was used to achieve consensus on statements relating to anticoagulant use in advanced kidney disease. Three Delphi rounds were predefined, with two rounds of questionnaires followed by online discussion in round three. Panel members included UK experts from the fields of cardiology, nephrology and haematology, who were asked to rate 160 statements with appropriateness and consensus defined by RAND methodology. Results: Twenty-one experts completed rounds one and two of the Delphi. For round three, 11 experts joined a Microsoft Teams discussion. Following round three, there were 72 statements with consensus agreement for inclusion in the guideline, including dose reduction recommendations for therapeutic light molecular weight heparin (LMWH), recommendation for off-label apixaban use in non-valvular atrial fibrillation, and trough anti-Xa level monitoring with therapeutic LMWH. Forty-two statements with consensus disagreement for exclusion and 27 with unequivocal consensus. These statements could be used to develop research recommendations. Conclusion: This study has led to consensus agreement on a number of statements relating to anticoagulant use in advanced kidney disease in the UK that can be used in national guidance. (© The Author(s) 2026. Published by Oxford University Press on behalf of Societa Italiana Nefrologia/Italian Society of Nephrology; Society ownership.) |
| Competing Interests: | Conflicts of interest: In the last three years KP has received honoraria from Bayer Plc, Vifor Pharma, Astellas, Stada UK Thornton and Ross. KP has an editorial role on Renal Review (Omnia media) and is Academic Vice President of the UK Kidney Association. JH, JT, JT2, PL, SC and SM have no conflicts of interest to declare. |
| Grant Information: | NIHR300545 National Institute for Health Research; Department of Health and Social Care |
| Contributed Indexing: | Keywords: advanced kidney disease; anticoagulation; atrial fibrillation; venous thromboembolism |
| Substance Nomenclature: | 0 (Anticoagulants) 0 (Heparin, Low-Molecular-Weight) 0 (Pyridones) 0 (Pyrazoles) 3Z9Y7UWC1J (apixaban) |
| Entry Date(s): | Date Created: 20260812 Date Completed: 20261010 Latest Revision: 20261010 |
| Update Code: | 20261010 |
| DOI: | 10.1093/joneph/aajag103 |
| PMID: | 42583885 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1724-6059 |
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| DOI: | 10.1093/joneph/aajag103 |