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. 2025 Feb;48(2):257-267.
doi: 10.1007/s40618-024-02458-4. Epub 2024 Oct 8.

Areas of uncertainty on the diagnosis, treatment, and follow-up of hypophosphatemia in adults: an Italian Delphi consensus

Iacopo Chiodini  1   2 , Daniela d'Angela  3 , Alberto Falchetti  2 , Luigi Gennari  4 , Nazzarena Malavolta  5 , Laura Masi  6 , Antonio Migliore  3 , Massimiliano Orso  7 , Barbara Polistena  3 , Domenico Rendina  8 , Alfredo Scillitani  9 , Federico Spandonaro  3   10 , Giuseppe Vezzoli  11 , Fabio Vescini  12 ; Delphi Panel Members
Collaborators, Affiliations

Areas of uncertainty on the diagnosis, treatment, and follow-up of hypophosphatemia in adults: an Italian Delphi consensus

Iacopo Chiodini et al. J Endocrinol Invest. 2025 Feb.

Abstract

Purpose: The study aimed to present the results of a Delphi consensus involving Italian experts focusing on the management of hypophosphatemia in adults.

Methods: A multidisciplinary advisory board of nine physicians, experts in hypophosphatemia management, was established. Next, a literature search was performed to identify international guidelines, consensus, and clinical pathways, which were later presented to the advisory board. Collaboratively, the advisory board and authoring team selected key statements for the consensus process and focused on areas of uncertainty related to the management of hypophosphatemia. The advisory board also indicated the experts to be invited to participate in the consensus process. The Delphi method was employed to reach a consensus.

Results: The literature search yielded one guideline, five consensus documents, and one clinical pathway. While our search strategy aimed to identify documents on the management of all types of hypophosphatemia, most of the guidelines and consensus documents retrieved focused on X-linked hypophosphatemia. The consensus process focused on 11 key issues, achieving strong convergence (over 70% consensus) in the first Delphi round for 8 out of the 11 statements. Three statements proceeded to the second round, with strong agreement reached for two. Notably, consensus was not reached for the statement concerning the measurement of fibroblast growth factor 23 for diagnostic purposes.

Conclusion: The study revealed that the community of clinical experts is well-informed and in agreement regarding hypophosphatemia management. It emphasized the importance of developing clear national guidance documents to support clinicians and multidisciplinary teams in patient management. These documents are crucial not only for healthcare professionals but also for those responsible for defining pathways and services, facilitating a more accurate management of hypophosphatemic patients.

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Conflict of interest statement

Declarations. Research involving human participants and/or animals: This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent: For this type of study, formal consent is not required. Conflict of interest: Iacopo Chiodini: no competing interests to declare that are relevant to the content of this article. Daniela d’Angela: no competing interests to declare that are relevant to the content of this article. Alberto Falchetti: no competing interests to declare that are relevant to the content of this article. Luigi Gennari: no competing interests to declare that are relevant to the content of this article. Nazzarena Malavolta: no competing interests to declare that are relevant to the content of this article. Laura Masi: no competing interests to declare that are relevant to the content of this article. Antonio Migliore: no competing interests to declare that are relevant to the content of this article. Massimiliano Orso: no competing interests to declare that are relevant to the content of this article. Barbara Polistena declares to have received in the last 5 years payments or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events from the following commercial sources: Amicus, Amgen, UCB. Domenico Rendina declares to have received in the last 5 years payments or honoraria for manuscript writing from the following commercial sources: Kyowa Kirin. Alfredo Scillitani: no competing interests to declare that are relevant to the content of this article. Federico Spandonaro declares to have received in the last 5 years payments or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events from the following commercial sources: Allergan, Amgen, Astellas, Baxter, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Janssen Cilag, Jazzpharma, Mylan, Nestle´ HS, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi, Servier, Shire, Takeda, Teva; in addition, he received consulting fees from Amgen. Giuseppe Vezzoli declares to have participated in an advisory board of Kiowa Kirin and to have received two honoraria for lectures from Kiowa Kirin. Fabio Vescini: no competing interests to declare that are relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Scores of the proposed statements (first Delphi round). Results are presented in %
Fig. 2
Fig. 2
Scores of the proposed statements (second Delphi round). Results are presented in %
See this image and copyright information in PMC

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