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Abstract: PO1641

An International Delphi Survey on IgA Nephropathy: Results from the DEFINE Physicians Study

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials


  • Vivarelli, Marina, Bambino Gesù Pediatric Hospital Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
  • Floege, Jürgen, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
  • Barratt, Jonathan, University of Leicester, Leicester, United Kingdom
  • Coppo, Rosanna, Regina Margherita Hospital, Turin, Italy
  • Lafayette, Richard A., Stanford University, Stanford, California, United States
  • Radhakrishnan, Jai, Columbia University Medical Center, New York, New York, United States
  • Rovin, Brad H., The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Selewski, David T., Medical University of South Carolina, Charleston, South Carolina, United States
  • Tesar, Vladimir, Charles University, Prague, Czechia
  • Tonelli, Marcello, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  • Reich, Heather N., University Health Network and University of Toronto, Toronto, Ontario, Canada

It is unclear whether treatment guidelines for patients with IgA nephropathy (IgAN) are uniformly applied in clinical practice. The DEFINE: Physicians initiative sought to describe the opinions of nephrologists about the pathophysiology, diagnosis, and optimal management of adult and pediatric patients with IgAN.


A 2-round Delphi survey was distributed to nephrologists in Canada, France, Germany, Italy, Spain, the UK, and the US. A 1-9 Likert scale (9=strongly agree) was used to score statements. Consensus was defined as median and mean score ≥7, and ≥75% of participants scoring agreement (ie, score 7-9). Feedback collected in Round 1 was used to revise statements not achieving high consensus (≥90% agreement) for retesting in Round 2. Moderate consensus was defined as 75-89% agreement.


In Round 1, 207 participants with a median clinical experience of 18 years (range, 5-49) rated 19 statements about IgAN. Half (50%) of participants worked in nonacademic settings. All statements met criteria for moderate or high consensus after the second round. Notably, a statement on corticosteroid therapy in adult patients reached moderate consensus after Round 1 and was divided into 2 parts in Round 2 (Figure 1). Both revised statements reached levels of agreement similar to the original statement. In contrast, a statement on corticosteroid and cyclophosphamide use in adults with rapidly progressive glomerulonephritis and 2 statements on corticosteroid therapy in pediatric patients reached high consensus in Round 1 (Figure 1).


High consensus regarding clinical decisions and the importance of controlling proteinuria in IgAN was observed in this Delphi survey. Although the level of consensus related to corticosteroid use was lower for adult patients vs pediatric patients, the level of consensus was relatively high for both groups.

Figure 1


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