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

被引：217

作者：

Cheung, Alfred K. ^{[1
]}

Chang, Tara, I ^{[2
]}

Cushman, William C. ^{[3
]}

Furth, Susan L. ^{[4
,5
]}

Hou, Fan Fan ^{[6
]}

Ix, Joachim H. ^{[7
,8
]}

Knoll, Gregory A. ^{[9
]}

Muntner, Paul ^{[10
]}

Pecoits-Filho, Roberto ^{[11
,12
]}

Sarnak, Mark J. ^{[13
]}

Tobe, Sheldon W. ^{[14
,15
]}

Tomson, Charles R., V ^{[16
]}

Lytvyn, Lyubov ^{[17
,18
]}

Craig, Jonathan C. ^{[19
,20
]}

Tunnicliffe, David J. ^{[20
,21
]}

Howell, Martin ^{[20
,21
]}

Tonelli, Marcello ^{[22
]}

Cheung, Michael ^{[23
]}

Earley, Amy ^{[23
]}

Mann, Johannes F. E. ^{[24
,25
]}

机构：

[1] Univ Utah Hlth, Dept Internal Med, Div Nephrol & Hypertens, Salt Lake City, UT USA

[2] Stanford Univ, Sch Med, Div Nephrol, Palo Alto, CA 94304 USA

[3] Univ Tennessee, Ctr Hlth Sci, Dept Prevent Med, Memphis, TN 38163 USA

[4] Univ Penn, Perelman Sch Med, Dept Pediat, Philadelphia, PA 19104 USA

[5] Childrens Hosp Philadelphia, Div Nephrol, Philadelphia, PA 19104 USA

[6] Southern Med Univ, Nanfang Hosp, Div Nephrol, Guangzhou, Guangdong, Peoples R China

[7] Univ Calif San Diego, Dept Med, Div Nephrol & Hypertens, San Diego, CA 92103 USA

[8] Vet Affairs San Diego Healthcare Syst, Nephrol Sect, La Jolla, CA USA

[9] Univ Ottawa, Ottawa Hosp, Dept Med, Ottawa, ON, Canada

[10] Univ Alabama Birmingham, Sch Publ Hlth, Dept Epidemiol, Birmingham, AL 35294 USA

[11] Arbor Res Collaborat Hlth, Ann Arbor, MI USA

[12] Pontificia Univ Catolica Parana, Sch Med, Curitiba, Parana, Brazil

[13] Tufts Med Ctr, Dept Med, Div Nephrol, Boston, MA 02111 USA

[14] Univ Toronto, Dept Med, Div Nephrol, Toronto, ON, Canada

[15] Northem Ontario Sch Med, Sudbury, ON, Canada

[16] Newcastle Upon Tyne Hosp NHS Trust, Freeman Hosp, Newcastle Upon Tyne, Tyne & Wear, England

[17] MAGIC Evidence Ecosyst Fdn, Hamilton, ON, Canada

[18] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[19] Flinders Univ S Australia, Coll Med & Publ Hlth, Adelaide, SA, Australia

[20] Cochrane Kidney & Transplant, Sydney, NSW, Australia

[21] Univ Sydney, Sydney Sch Publ Hlth, Sydney, NSW, Australia

[22] Univ Calgary, Calgary, AB, Canada

[23] KDIGO, Brussels, Belgium

[24] KfH Kidney Ctr, Isoldenst 15, DE-80804 Munich, Germany

[25] Friedrich Alexander Univ Erlangen Nurnberg, Erlangen, Germany

来源：

KIDNEY INTERNATIONAL | 2021年 / 99卷 / 03期

基金：

美国国家卫生研究院;

关键词：

albuminuria; ambulatory blood pressure monitoring; angiotensin-converting enzyme inhibitor; angiotensin II receptor blocker; anti-hypertensive agents; automated office blood pressure; blood pressure measurement; blood pressure targets; children; chronic kidney disease; creatinine; diabetes; dietary sodium; evidence-based; guideline; home blood pressure monitoring; hyperkalemia; KDIGO; kidney transplant recipient; lifestyle; mineralocorticoid receptor antagonist; office blood pressure; physical activity; potassium; proteinuria; renin-angiotensin system; standardized office blood pressure; systematic review; weight loss; CARDIOVASCULAR OUTCOMES; RENAL-FAILURE; PROGRESSION; HYPERTENSION; PREVENTION; BENAZEPRIL; ADULTS; TRIAL; RISK;

D O I：

10.1016/j.kint.2020.10.026

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

The Kidney Disease: Improving Global Outcomes (KDIGO) 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease for patients not receiving dialysis represents an update to the KDIGO 2012 guideline on this topic. Development of this guideline update followed a rigorous process of evidence review and appraisal. Guideline recommendations are based on systematic reviews of relevant studies and appraisal of the quality of the evidence. The strength of recommendations is based on the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) approach. The scope includes topics covered in the original guideline, such as optimal blood pressure targets, lifestyle interventions, antihypertensive medications, and specific management in kidney transplant recipients and children. Some aspects of general and cardiovascular health, such as lipid and smoking management, are excluded. This guideline also introduces a chapter dedicated to proper blood pressure measurement since all large randomized trials targeting blood pressure with pivotal outcomes used standardized preparation and measurement protocols adhered to by patients and clinicians. Based on previous and new evidence, in particular the Systolic Blood Pressure Intervention Trial (SPRINT) results, we propose a systolic blood pressure target of less than 120 mm Hg using standardized office reading for most people with chronic kidney disease (CKD) not receiving dialysis, the exception being children and kidney transplant recipients. The goal of this guideline is to provide clinicians and patients a useful resource with actionable recommendations supplemented with practice points. The burden of the recommendations on patients and resources, public policy implications, and limitations of the evidence are taken into consideration. Lastly, knowledge gaps and recommendations for future research are provided.

引用

页码：559 / 569

页数：11

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