Kidney Disease Experts Support Standardization of Measuring Blood Pressure and Other 2021 Guidelines

Updated: Apr 24

From National Kidney Foundation


January 18, 2022, New York, NY — The National Kidney Foundation's (NKF) work group of kidney disease experts released their commentary today in the American Journal of Kidney Diseases (AJKD) regarding the latest clinical guidelines for managing blood pressure in people with chronic kidney disease (CKD).


NKF’s Kidney Disease Outcomes Quality Initiative (KDOQI) convened a work group to review the 2021 Kidney Disease: Improving Global Outcomes (KDIGO) guideline for the management of blood pressure in CKD.


High blood pressure (BP) is the leading modifiable chronic disease risk factor in the world. High BP is not only an important risk factor for CKD and kidney failure, but is highly prevalent in patients with CKD, including kidney transplant recipients.


The combination of CKD and hypertension leads to an increased risk for cardiovascular disease (heart disease), which is the most common cause of morbidity and mortality in patients with CKD. Fortunately, interventions to lower BP reduce the risk for heart disease in patients with CKD, the authors of the commentary report.


“A critical addition to the KDIGO guideline is the recommendation for accurate assessment of blood pressure using standardized office blood pressure measurement,” said KDOQI co-author Paul E. Drawz, MD, MHS, MS, Division of Nephrology and Hypertension, University of Minnesota, Minneapolis. “In the general adult population with CKD, KDIGO recommends a goal systolic blood pressure less than 120 mm Hg based on results from the Systolic Blood Pressure Intervention Trial (SPRINT) and secondary analyses of the Action to Control Cardiovascular Risk in Diabetes-Blood Pressure (ACCORD-BP) trial. The KDOQI work group agreed with most of the recommendations while highlighting the weak evidence base especially for patients with diabetes and advanced CKD.”


This commentary is the product of the KDOQI working group and presents the recommendations and practice points from the KDIGO guideline in the context of US clinical practice.


“It has been an honor to collaborate with all of the hypertension and CKD experts on the KDOQI work group,” Dr. Drawz said. “We hope this commentary will provide guidance to providers as they work with their patients who have CKD to reduce the burden of hypertension-related morbidity and mortality.”


The KDOQI commentators are Drawz; Srinivasan Beddhu, MD, University of Utah School of Medicine, Salt Lake City; O.N. Ray Bignall II, MD, Department of Pediatrics, The Ohio State University College of Medicine, Division of Nephrology and Hypertension, Nationwide Children’s Hospital, Columbus; Jordana B. Cohen, MD, University of Pennsylvania Perelman School of Medicine, Philadelphia; Joseph T. Flynn, MD, Department of Pediatrics, University of Washington School of Medicine; Division of Nephrology, Seattle Children’s Hospital, Seattle; Elaine Ku, MD, University of California–San Francisco; Mahboob Rahman, MD; University Hospitals Cleveland Medical Center, Case Western Reserve University, Louis Stokes Cleveland VA Medical Center Cleveland, Ohio; George Thomas, MD, Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio: Matthew R. Weir, MD, Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore; and Paul K. Whelton, MD, Department of Epidemiology, Tulane University School of Public Health & Tropical Medicine, New Orleans.


To read the KDOQI commentary, go to https://www.ajkd.org/article/S0272-6386(21)00949-5/fulltext

Kidney Disease Facts

In the United States, 37 million adults are estimated to have chronic kidney disease (CKD)—and approximately 90 percent don’t know they have it. 1 in 3 adults in the U.S. is at risk for chronic kidney disease. Risk factors for kidney disease include: diabetes, high blood pressure, heart disease, obesity and family history. People who are Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian American, or Native Hawaiian or Other Pacific Islander are at increased risk for developing the disease. Black or African American people are almost 4 times more likely than Whites to have kidney failure. Hispanic or Latino people are 1.3 times more likely than non-Hispanic or non-Latino people to have kidney failure.


About the American Journal of Kidney Diseases

The American Journal of Kidney Diseases (AJKD), the official journal of the National Kidney Foundation, is recognized worldwide as a leading source of information devoted to clinical nephrology practice and clinical research. Articles selected for publication in AJKD undergo a rigorous consideration process, supporting the journal's goal to communicate important new information in clinical nephrology in a way that strengthens knowledge and helps physicians to provide their patients with the highest standard of care.

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