Developing consensus-based symptom-management guidance for advanced kidney disease: findings from a national Delphi study

Several pharmacological and non-pharmacological interventions are used to manage physical symptoms in advanced kidney disease (AKD). Adults with AKD and kidney healthcare professionals require guidance in identifying and prioritizing relevant symptom-management interventions. The aim of this study was to develop a consensus-based symptom-management guidance for adults with AKD and kidney healthcare professionals. A four-round Delphi study was conducted across Denmark to achieve consensus on symptom-management among a national expert panel of adults with AKD and kidney healthcare professionals. A classical anonymous Delphi design was selected to reduce group conformity and allow independent reassessment of responses across iterative rounds. A pragmatic literature search, alongside suggestions from the expert panel, was used to identify potential interventions. Participants rated the relevance, importance, and frequency of intervention through a series of online surveys. Consensus was defined as > 70% agreement. The expert panel consisted of 54 participants, the majority of whom had more than 10 years of nephrology experience. Four Delphi rounds were completed, with response rates of 83%, 67%, 63%, and 59% respectively. The literature search identified 216 interventions with varying levels of evidence, and an additional 80 interventions were suggested by the expert panel. Overall, 242 interventions achieved consensus agreement above 70%. In the final Delphi round, interventions were prioritized according to their perceived importance and frequency in nephrology practice. This study developed a national consensus-based symptom-management guidance for adults with AKD. By integrating available evidence, clinical expertise, and patient perspectives, the study provides a foundation for future development and evaluation of symptom-management support resources in nephrology care.