Executive summary of the KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease

Cheung, Alfred K.; Chang, Tara I.; Cushman, William C.; Furth, Susan L.; Hou, Fan Fan; Ix, Joachim H.; Knoll, Gregory A.; Muntner, Paul; Pécoits-Filho, Roberto; Sarnak, Mark J.; Tobe, Sheldon W.; Tomson, Charles; Lytvyn, Lyubov; Craig, Jonathan C.; Tunnicliffe, David J.; Howell, Martin; Tonelli, Marcello; Cheung, Michael; Earley, Amy; Mann, Johannes F.E.

doi:10.1016/j.kint.2020.10.026

Cited by 196 publications

(206 citation statements)

References 27 publications

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“…According to Dryad's terms of service, researchers can use these data for secondary analysis without infringing on the author's rights. All eligible individuals who were not undergoing dialysis were diagnosed with stage G2–G5 CKD based on the Kidney Disease Improving Global Outcomes classification [ 18 ]. All participants were at least 20 years of age and visited nephrology centers for the first time between October 2010 and December 2011.…”

Section: Methodsmentioning

confidence: 99%

An easy-to-operate web-based calculator for predicting the progression of chronic kidney disease

Wang

Fang

et al. 2021

J Transl Med

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Background This study aimed to establish and validate an easy-to-operate novel scoring system based on simple and readily available clinical indices for predicting the progression of chronic kidney disease (CKD). Methods We retrospectively evaluated 1045 eligible CKD patients from a publicly available database. Factors included in the model were determined by univariate and multiple Cox proportional hazard analyses based on the training set. Results Independent prognostic factors including etiology, hemoglobin level, creatinine level, proteinuria, and urinary protein/creatinine ratio were determined and contained in the model. The model showed good calibration and discrimination. The area under the curve (AUC) values generated to predict 1-, 2-, and 3-year progression-free survival in the training set were 0.947, 0.931, and 0.939, respectively. In the validation set, the model still revealed excellent calibration and discrimination, and the AUC values generated to predict 1-, 2-, and 3-year progression-free survival were 0.948, 0.933, and 0.915, respectively. In addition, decision curve analysis demonstrated that the model was clinically beneficial. Moreover, to visualize the prediction results, we established a web-based calculator (https://ncutool.shinyapps.io/CKDprogression/). Conclusion An easy-to-operate model based on five relevant factors was developed and validated as a conventional tool to assist doctors with clinical decision-making and personalized treatment.

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Section: Methodsmentioning

confidence: 99%

An easy-to-operate web-based calculator for predicting the progression of chronic kidney disease

Wang

Fang

et al. 2021

J Transl Med

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“…While CKD guidelines support a systolic blood pressure <120mmHg 33 , this goal may not be prudent for older adults with CKD. This intensive blood pressure target was derived from the Systolic Blood Pressure Intervention Trial (SPRINT) which demonstrated reduced cardiovascular events and mortality benefit.…”

Section: Less Intensive Management Of Diabetes and Hypertensionmentioning

confidence: 99%

Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review

Mohottige

Manley²,

Hall

2021

Kidney360

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Due to both age and impaired kidney function, older adults with kidney disease are at increased risk of medication-related problems and related hospitalizations. One proactive approach to minimize this risk is deprescribing. Deprescribing refers to the systematic process of reducing or stopping a medication. Aside from preventing harm, deprescribing can potentially optimize patients' quality of life by aligning medications with their goals of care. For some patients, deprescribing could involve less aggressive management of their diabetes and/or hypertension. In other instances, deprescribing targets may include potentially inappropriate medications that carry greater risk of harm than benefit in older adults, medications that have questionable efficacy, including medications that have varying efficacy by degree of kidney function, and that increase medication regimen complexity. We include a guide for clinicians to utilize in deprescribing, the List, Evaluate, Shared Decision-Making, Support (LESS) framework. The LESS framework provides key considerations at each step of the deprescribing process that can be tailored for the medications and context of individual patients. Patient characteristics or clinical events that warrant consideration of deprescribing include limited life expectancy, cognitive impairment, and health status changes, such as dialysis initiation or recent hospitalization. We acknowledge patient, clinician, and system-level challenges to the deprescribing process. These include patient hesitancy and challenges to discussing goals of care, clinician time constraints and a lack of evidence-based guidelines, as well as system-level challenges of interoperable electronic health records and limited incentives for deprescribing. However, novel evidence-based tools designed to facilitate deprescribing and future evidence on effectiveness of deprescribing could help mitigate these barriers. This review provides foundational knowledge on deprescribing as an emerging component of clinical practice and research within nephrology.

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“…1 ). Die aktuellen 2021er KDIGO-Blutdruckleitlinien für Patienten mit CKD empfehlen, ACE‑I oder ARB für hypertensive CKD-Patienten mit Albuminurie von 300 mg/Tag oder mehr und bei Albuminurie zwischen 30 und 299 mg/Tag dann einzusetzen, wenn gleichzeitig ein Diabetes mellitus vorliegt (jeweils Empfehlungs‑/Evidenzgrad 1B; [ 7 ]). Für Patienten ohne Diabetes mit moderater Albuminurie (30–299 mg/Tag) wird hier ebenfalls eine Anwendung vorgeschlagen (Empfehlungs‑/Evidenzgrad 2C; Tab.…”

Section: Hemmung Des Raas Durch Ace-hemmer (Suffix „-Pril“) Und Arb (Suffix „-Sartan“)unclassified

“…sprach eine Kontraindikation für eine Kombinationstherapie bei Patienten mit Diabetes mellitus oder einer GFR von weniger als 60 ml/min aus. Auch die 2021er KDIGO-Blutdruckleitlinien für Patienten mit CKD raten von direkten Renininhibitoren in Kombinationstherapie mit ACE‑I oder ARB ausdrücklich ab [ 7 ]. Trotz theoretischer Überlegungen zu einem möglichen Nutzen der Substanzklasse scheint es vor diesem Hintergrund momentan unwahrscheinlich, dass es nochmals weitere große Studien zur Progressionshemmung bei CKD geben wird.…”

Section: Direkte Renininhibtion (Aliskiren)unclassified

Blockierung des Renin-Angiotensin-Aldosteron-Systems

Schmitt

2021

Nephrologe

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Chronische Nierenerkrankungen gehen in der Regel mit einem relativ langsamen Nierenfunktionsverlust einher. Dadurch bietet sich prinzipiell die Möglichkeit, mit einer effizienten medikamentösen Therapie einzugreifen. Die Voraussetzung ist, dass sich klare therapeutische Angriffspunkte identifizieren lassen. Einer der wichtigsten Angriffspunkte ist das Renin-Angiotensin-Aldosteron-System (RAAS), dessen Aktivierung zur Progression und Nierenfunktionsverschlechterung entscheidend beiträgt. Dieser Artikel gibt eine Übersicht über die pathomechanistischen Grundlagen des RAAS-vermittelten Nierenschadens und die medikamentösen Möglichkeiten zur RAAS-Hemmung. Die Evidenz aus klinischen Studien zur Nephroprotektion wird zusammengefasst, und die internationalen Leitlinienempfehlungen werden besprochen. Als Ausblick wird die neue Möglichkeit einer kombinierten Add-on-Therapie mit nichtsteroidalen Mineralokortikoidrezeptorantagonisten anhand der FIDELIO-DKD-Studie diskutiert.

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Executive summary of the KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease

Cited by 196 publications

References 27 publications

An easy-to-operate web-based calculator for predicting the progression of chronic kidney disease

An easy-to-operate web-based calculator for predicting the progression of chronic kidney disease

Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review

Blockierung des Renin-Angiotensin-Aldosteron-Systems

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