Elsevier

Kidney International

Volume 83, Issue 3, March 2013, Pages 377-383
Kidney International

Review
Summary of KDIGO guideline. What do we really know about management of blood pressure in patients with chronic kidney disease?

https://doi.org/10.1038/ki.2012.425Get rights and content
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The Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for management of blood pressure (BP) in chronic kidney disease (CKD) supersedes the 2004 Kidney Disease Quality Outcomes Initiative document on this topic. The new guideline has been designed to assist clinical decision making in patients with CKD who are not receiving dialysis. The recommendations in the guideline acknowledge that no single BP target is optimal for all CKD patients and encourage individualization of treatment depending on age, the severity of albuminuria, and comorbidities. In general, the available evidence indicates that in CKD patients without albuminuria the target BP should be ≤140 mm Hg systolic and ≤90 mm Hg diastolic. However, in most patients with an albumin excretion rate of ≥30 mg/24 h (i.e., those with both micro- and macroalbuminuria), a lower target of ≤130 mm Hg systolic and ≤80 mm Hg diastolic is suggested. In achieving BP control, the value of lifestyle changes and the need for multiple pharmacological agents is acknowledged. Use of agents that block the renin–angiotensin–aldosterone system is recommended or suggested in all patients with an albumin excretion rate of ≥30 mg/24 h. Recommendations are almost identical in CKD patients with and without diabetes. Special considerations relevant to children and those of older age and those who have received a kidney transplant are included. Ongoing controversies in BP management in the context of CKD are highlighted along with key areas for future research.

Keywords

blood pressure
chronic kidney disease
clinical practice guideline
evidence-based recommendation
hypertension
KDIGO

Cited by (0)

DCW reported receiving consultancy fees from Amgen, honoraria from Abbott, Amgen, Fresenius, Otsuka and Shire; travel stipends from Amgen, Merck Sharp and Dohme and Shire; and grant/research support from Abbott and Genzyme. GJB reported no relevant financial relationships.