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. 2025 Apr 18;15(1):13494.
doi: 10.1038/s41598-025-91731-4.

Mortality among individuals with chronic kidney disease based on the 2012 and 2021 KDIGO blood pressure targets

Sijue Zou  1   2   3 , Yan Zhang  1   2   3 , Xin He  1   2   3 , Jiawei Cheng  1   2   3 , Songkai Wang  1   2   3 , Yiwei Xiong  1   2   3 , Zhangzhe Peng  1   2   3 , Xiang Ao  4 , Qiongjing Yuan  5   6   7
Affiliations

Mortality among individuals with chronic kidney disease based on the 2012 and 2021 KDIGO blood pressure targets

Sijue Zou et al. Sci Rep. .

Abstract

The 2021 Kidney Disease: Improving Global Prognosis (KDIGO) guidelines set a target systolic blood pressure (SBP) of 120 mmHg for chronic kidney disease (CKD) patients. This paper aims to compare mortality outcomes in CKD patients following the 2021 KDIGO guidelines versus the 2012 KDIGO guidelines. We used the National Health and Nutrition Examination Survey (NHANES) database to categorize CKD patients into four groups: "above 2021 KDIGO only", "above 2012 KDIGO only", "above both targets" and "controlled with both targets". We compared differences in all-cause and cardiovascular deaths among these groups. In total, 10,612 CKD patients from the 2001-2018 NHANES database were identified. Subsequently, 2,226 patients lacking mortality information and 1,157 without crucial laboratory data were excluded. 7,229 CKD patients were enrolled, with 50.67% above both targets, 27.1% controlled within both targets, 1.01% above the 2012 KDIGO target, and 21.22% only above the 2021 KDIGO target. In multivariate analyses, the risk of all-cause mortality was not statistically significant (hazard ratio (HR): 0.91, 95% confidence interval (CI): 0.8-1.02, P = 0.11) for patients above the 2021 KDIGO target only compared to those controlled with both targets. Similar results were found for cardiovascular deaths. The 2021 KDIGO guidelines did not differentiate high-risk CKD populations in terms of all-cause death and cardiovascular death, compared with the 2012 KDIGO guidelines.

Keywords: Blood pressure; Chronic kidney disease; Guideline; Mortality; NHANES.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Institutional review board statement: NHANES protocol was approved by the Research Ethics Review Board of National Center for Health Statistics. All participants provided informed consent prior to participating in NHANES. The Ethical Approval Code/Number is available from the published NCHS Ethics Review Board (ERB) Approval online ( https://www.cdc.gov/nchs/nhanes/irba98.htm#print ). Informed consent statement: Informed consent was obtained from all subjects involved in NHANES.

Figures

Fig. 1
Fig. 1
Flowchart of included patients in this study (n = 7,229). CKD chronic kidney disease, NHANES National Health and Nutrition Examination Survey, eGFR estimated glomerular filtration rate, UACR urinary albumin-to-creatinine ratio, BMI body mass index.
Fig. 2
Fig. 2
The classification and distribution of systolic and diastolic blood pressure of the NHANES examinees and their corresponding blood pressure statuses. KDIGO Kidney Disease: Improving Global Outcomes, UACR urinary albumin-to-creatinine ratio, BP blood pressure, SBP systolic blood pressure, DBP diastolic blood pressure.
Fig. 3
Fig. 3
Kaplan-Meier curve for all-cause mortality according to blood pressure statuses.
Fig. 4
Fig. 4
Cumulative cardiovascular deaths according to blood pressure statuses.
Fig. 5
Fig. 5
Association between blood pressure statuses and (a) all-cause mortality and (b) cardiovascular mortality in our study (adjusted for age, sex, race, hyperlipidemia, hemoglobin, CCB use, RASI use, diuretics use, beta-blockers use, smoking status, BMI, the history of congestive heart failure and coronary heart disease, eGFR).
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