An International Delphi Survey on IgA Nephropathy: Results from the DEFINE Physicians Study
Bibliographic record
Abstract
Background: 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. Methods: 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. Results: 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).Figure 1Conclusions: 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. Funding: Commercial Support - Travere Therapeutics, Inc.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.059 | 0.069 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.006 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".