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; Mann, Johannes F.E.

doi:10.1016/j.kint.2020.11.003

Cited by 640 publications

(473 citation statements)

References 338 publications

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“…The KDIGO 2021 BP guidelines recommend use of standardized rather than routine office BP measurement [ 25 ], as suggested by the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines [ 32 ]. Standardized office BP measurement refers to BP measurement following the recommended preparation procedure.…”

Section: Bp Measurementmentioning

confidence: 99%

“…This conventional concept has been challenged by the results of the Systolic Blood Pressure Intervention Trial (SPRINT) study, which demonstrated the benefit of intensive control of SBP < 120 mmHg compared with the conventional target of < 140 mmHg [ 24 ]. The SPRINT study results are included in the Kidney Disease: Improving Global Outcomes (KDIGO) 2021 guidelines, which suggest a target SBP of < 120 mmHg in patients with CKD [ 25 ]. However, not all studies favor this lower target, given the negative results of intensive BP control [ 26 - 28 ].…”

Section: Introductionmentioning

confidence: 99%

“…In fact, some guidelines still recommend the conventional BP target for patients with CKD [ 29 - 31 ]. BP targets in patients with CKD are listed in Table 1 [ 18 , 19 , 22 , 25 , 32 - 35 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Blood pressure control in patients with chronic kidney disease

Lee

Han

2021

Korean J Intern Med

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Uncontrolled blood pressure (BP) in patients with chronic kidney disease (CKD) can lead to serious adverse outcomes. To prevent the occurrence of cardiovascular events (CVEs), and end-stage kidney disease, achieving an optimal BP level is important. Recently, there has been a paradigm shift in the management of BP largely as a result of the Systolic Blood Pressure Intervention Trial (SPRINT), which showed a reduction in CVEs by lowering systolic BP to 120 mmHg. A lower systolic blood pressure (SBP) target has been accepted by the Kidney Disease: Improving Global Outcomes (KDIGO) 2021 guidelines. However, whether intensive control of SBP targeting < 120 mmHg is also effective in patients with CKD is controversial. Notably, this lower target SBP is associated with a higher risk of adverse kidney outcomes. Unfortunately, there have been no randomized controlled trials on this issue involving only patients with CKD, particularly those with advanced CKD. In this review, we discuss the optimal control of BP in patients with CKD in terms of reduction in death and CVEs as well as attenuation of CKD progression based on the evidence-based literature.

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Section: Bp Measurementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Blood pressure control in patients with chronic kidney disease

Lee

Han

2021

Korean J Intern Med

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“…In addition, OH was diagnosed using only baseline BP measurements, as longitudinal data were not available. However, BP measurements were evaluated according to a standardized protocol of ESC/ESH [ 29 ] and are in line with the latest KDIGO guidelines [ 50 ], which, even though not focused on the diagnosis of OH, recommends that the patient relax for at least 5 min before BP measurement. Finally, although OH is associated with a higher risk of falls [ 26 ], during the follow-up no falls leading to significant clinical consequences (fractures, trauma, hospital admissions) were recorded in clinical records.…”

Section: Discussionmentioning

confidence: 99%

Clinical Epidemiology of Systolic and Diastolic Orthostatic Hypotension in Patients on Peritoneal Dialysis

Torino

Tripepi

Versace

et al. 2021

JCM

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Blood pressure changes upon standing reflect a hemodynamic response, which depends on the baroreflex system and euvolemia. Dysautonomia and fluctuations in blood volume are hallmarks in kidney failure requiring replacement therapy. Orthostatic hypotension has been associated with mortality in hemodialysis patients, but neither this relationship nor the impact of changes in blood pressure has been tested in patients on peritoneal dialysis. We investigated both these relationships in a cohort of 137 PD patients. The response to orthostasis was assessed according to a standardized protocol. Twenty-five patients (18%) had systolic orthostatic hypotension, and 17 patients (12%) had diastolic hypotension. The magnitude of systolic and diastolic BP changes was inversely related to the value of the corresponding supine BP component (r = −0.16, p = 0.056 (systolic) and r = −0.25, p = 0.003 (diastolic), respectively). Orthostatic changes in diastolic, but not in systolic, BP were linearly related to the death risk (HR (1 mmHg reduction): 1.04, 95% CI 1.01–1.07, p = 0.006), and this was also true for CV death (HR: 1.08, 95% CI 1.03–1.12, p = 0.001). The strength of this association was not affected by further data adjustment (p ≤ 0.05). These findings suggest that independent of the formal diagnosis of orthostatic hypotension, even minor orthostatic reductions in diastolic BP bear an excess death risk in this population.

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“…Albuminuria, which is a type of proteinuria wherein the protein albumin is abnormally present in the urine (usually, only trace amounts of albumin can be found in urine, as it is a major plasma protein that normally circulates in the blood), is considered a marker for microvascular and kidney damage, as well as an early indicator of diabetic kidney disease. According to the amount of urine protein content, albuminuria is divided into the following three categories according to the albumin–creatinine ratio (ACR) or the 24-h albumin excretion rate (AER): A1 or normoalbuminuria (<30 mg/g or <30 mg/24 h), A2 or microalbuminuria (30–300 mg/g or 30–300 mg/24 h) and A3 or macroalbuminuria (>300 mg/g or >300 mg/24 h) [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Diabetes, Albuminuria and the Kidney—Brain Axis

Ariton

Jiménez-Baladó

Maisterra

et al. 2021

JCM

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Cognitive decline and kidney disease are significant public health problems that share similar characteristics and risk factors. The pathophysiology of the kidney–brain axis is not completely understood, and studies analysing the relationship between the biomarkers of kidney damage and cognitive impairment show different results. This article focuses on the epidemiological and clinical aspects concerning the association of albuminuria, a marker for endothelial dysfunction and microvascular disease, and cognitive impairment in patients with chronic kidney disease, diabetic kidney disease and end-stage kidney disease. Most studies show a positive relationship between albuminuria and cognitive impairment in all groups, but evidence in type 2 diabetes (T2D) patients is limited. We briefly discuss the mechanisms underlying these associations, such as damage to the microvascular circulation, leading to hypoperfusion and blood pressure fluctuations, as well as increased inflammation and oxidative stress, both in the brain and in the kidneys. Further clinical and epidemiological studies developed to understand the interplay between the kidneys and brain diseases will hopefully lead to a reduction in cognitive impairment in these patients.

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

Cited by 640 publications

References 338 publications

Blood pressure control in patients with chronic kidney disease

Blood pressure control in patients with chronic kidney disease

Clinical Epidemiology of Systolic and Diastolic Orthostatic Hypotension in Patients on Peritoneal Dialysis

Diabetes, Albuminuria and the Kidney—Brain Axis

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