Management of Blood Pressure in Patients With Chronic Kidney Disease Not Receiving Dialysis: Synopsis of the 2021 KDIGO Clinical Practice Guideline

Charles R V Tomson¹, Alfred K Cheung², Johannes F E Mann³, Tara I Chang⁴, William C Cushman⁵, Susan L Furth⁶, Fan Fan Hou⁷, Gregory A Knoll⁸, Paul Muntner⁹, Roberto Pecoits-Filho¹⁰, Sheldon W Tobe¹¹, Lyubov Lytvyn¹², Jonathan C Craig¹³, David J Tunnicliffe¹⁴, Martin Howell¹⁴, Marcello Tonelli¹⁵, Michael Cheung¹⁶, Amy Earley¹⁶, Joachim H Ix¹⁷, Mark J Sarnak¹⁸

Affiliations

¹ Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom (C.R.T.).
² University of Utah, Salt Lake City, Utah (A.K.C.).
³ KfH Kidney Center, University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany (J.F.M.).
⁴ Stanford University, Palo Alto, California (T.I.C.).
⁵ University of Tennessee Health Science Center, Memphis, Tennessee (W.C.C.).
⁶ Perelman School of Medicine at the University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (S.L.F.).
⁷ Nanfang Hospital, Southern Medical University, Guangzhou, China (F.F.H.).
⁸ The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (G.A.K.).
⁹ University of Alabama at Birmingham, Birmingham, Alabama (P.M.).
¹⁰ Arbor Research Collaborative for Health, Ann Arbor, Michigan, and Pontifical Catholic University of Paraná, Curitiba, Brazil (R.P.).
¹¹ University of Toronto, Toronto, and Northern Ontario School of Medicine, Sudbury, Ontario, Canada (S.W.T.).
¹² MAGIC Evidence Ecosystem Foundation, McMaster University, Hamilton, Ontario, Canada (L.L.).
¹³ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, and Cochrane Kidney and Transplant, Sydney, New South Wales, Australia (J.C.C.).
¹⁴ Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia (D.J.T., M.H.).
¹⁵ University of Calgary, Calgary, Alberta, Canada (M.T.).
¹⁶ KDIGO, Brussels, Belgium (M.C., A.E.).
¹⁷ University of California San Diego and Veterans Affairs San Diego Healthcare System, San Diego, California (J.H.I.).
¹⁸ Tufts University, Boston, Massachusetts (M.J.S.).

PMID: 34152826
DOI: 10.7326/M21-0834

Free article

Practice Guideline

Management of Blood Pressure in Patients With Chronic Kidney Disease Not Receiving Dialysis: Synopsis of the 2021 KDIGO Clinical Practice Guideline

Charles R V Tomson et al. Ann Intern Med. 2021 Sep.

Free article

. 2021 Sep;174(9):1270-1281.

doi: 10.7326/M21-0834. Epub 2021 Jun 22.

Authors

Affiliations

¹ Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom (C.R.T.).
² University of Utah, Salt Lake City, Utah (A.K.C.).
³ KfH Kidney Center, University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany (J.F.M.).
⁴ Stanford University, Palo Alto, California (T.I.C.).
⁵ University of Tennessee Health Science Center, Memphis, Tennessee (W.C.C.).
⁶ Perelman School of Medicine at the University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (S.L.F.).
⁷ Nanfang Hospital, Southern Medical University, Guangzhou, China (F.F.H.).
⁸ The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (G.A.K.).
⁹ University of Alabama at Birmingham, Birmingham, Alabama (P.M.).
¹⁰ Arbor Research Collaborative for Health, Ann Arbor, Michigan, and Pontifical Catholic University of Paraná, Curitiba, Brazil (R.P.).
¹¹ University of Toronto, Toronto, and Northern Ontario School of Medicine, Sudbury, Ontario, Canada (S.W.T.).
¹² MAGIC Evidence Ecosystem Foundation, McMaster University, Hamilton, Ontario, Canada (L.L.).
¹³ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, and Cochrane Kidney and Transplant, Sydney, New South Wales, Australia (J.C.C.).
¹⁴ Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia (D.J.T., M.H.).
¹⁵ University of Calgary, Calgary, Alberta, Canada (M.T.).
¹⁶ KDIGO, Brussels, Belgium (M.C., A.E.).
¹⁷ University of California San Diego and Veterans Affairs San Diego Healthcare System, San Diego, California (J.H.I.).
¹⁸ Tufts University, Boston, Massachusetts (M.J.S.).

PMID: 34152826
DOI: 10.7326/M21-0834

Abstract

Description: The Kidney Disease: Improving Global Outcomes (KDIGO) 2021 clinical practice guideline for the management of blood pressure (BP) in patients with chronic kidney disease (CKD) not receiving dialysis is an update of the KDIGO 2012 guideline on the same topic and reflects new evidence on the risks and benefits of BP-lowering therapy among patients with CKD. It is intended to support shared decision making by health care professionals working with patients with CKD worldwide. This article is a synopsis of the full guideline.

Methods: The KDIGO leadership commissioned 2 co-chairs to convene an international Work Group of researchers and clinicians. After a Controversies Conference in September 2017, the Work Group defined the scope of the evidence review, which was undertaken by an evidence review team between October 2017 and April 2020. Evidence reviews were done according to the Cochrane Handbook. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to guide the development of the recommendations and rate the strength and quality of the evidence. Practice points were included to provide guidance when evidence was insufficient to make a graded recommendation. The guideline was revised after public consultation between January and March 2020.

Recommendations: The updated guideline comprises 11 recommendations and 20 practice points. This synopsis summarizes key recommendations pertinent to the diagnosis and management of high BP in adults with CKD, excluding those receiving kidney replacement therapy. In particular, the synopsis focuses on recommendations for standardized BP measurement and a target systolic BP of less than 120 mm Hg, because these recommendations differ from some other guidelines.

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Targeting the Standardized Blood Pressure: New Guidelines for Blood Pressure Management in Chronic Kidney Disease.
Thomas G, Gadegbeku CA. Thomas G, et al. Ann Intern Med. 2021 Sep;174(9):1321-1322. doi: 10.7326/M21-2571. Epub 2021 Jun 22. Ann Intern Med. 2021. PMID: 34152825 No abstract available.

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Management of Blood Pressure in Patients With Chronic Kidney Disease Not Receiving Dialysis: Synopsis of the 2021 KDIGO Clinical Practice Guideline

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Management of Blood Pressure in Patients With Chronic Kidney Disease Not Receiving Dialysis: Synopsis of the 2021 KDIGO Clinical Practice Guideline

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Abstract

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Publication types

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Medical

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