Clinical Practice Guidelines
KDIGO Guideline for Blood Pressure Management in CKD
The Work Group developing the KDIGO Clinical Practice Guideline on Blood Pressure Management in CKD is chaired by Drs. Gavin Becker and David Wheeler. It is anticipated that this guideline will publish in the second half of 2011.
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Guideline Workgroup Roster
| NAME/AFFILIATION | CONTACT INFORMATION |
| Co–Chair: Gavin J. Becker, MD, FRACP Professor and Director |
Department of Nephrology Director, Division of Medicine Royal Melbourne Hospital Department of Nephrology Victoria, 3050 AUSTRALIA |
| Co-Chair: David C. Wheeler, MD, FRCP Royal Free and University College Medical School |
Centre for Nephrology Hampstead Campus Rowland Hill Street London, NW3 2PF UNITED KINGDOM |
| Dick de Zeeuw, MD, PhD Professor and Chair |
Department of Clinical Pharmacology University Medical Center Groningen UMCG, Sector F PO Box 196 9700 AD Groningen NETHERLANDS |
| Toshiro Fujita, MD Professor and Chairman Chief, Division of Nephrology and Endocrinology |
Department of Internal Medicine University of Tokyo School of Medicine 7–3–1, Hongo, Bunkyo–ku,Tokyo 113–8655 JAPAN |
| Susan Furth, MD, PhD Chief, Division of Nephrology |
Division of Nephrology The Children’s Hospital of Philadelphia 34th Street and Civic Center Blvd Philadelphia, PA 19104–4399 USA |
| Hallvard Holdaas, MD, PhD | Medical Department, Oslo University Hospital Rikshospitalet, Sognsvannsvn 20, N–0027, Oslo NORWAY |
| Shanthi Mendis, MBBS MD FRCP FACC Coordinator, CV Unit Management of Noncommunicable Diseases |
Chronic Diseases and Prevention Management Cluster, World Health Organization 20 Avenue Appia CH–1211 Geneva 27, SWITZERLAND |
| Suzanne Oparil, MD Vascular Biology and Hypertension Program Division of Cardiovascular Disease |
Department of Medicine, University of Alabama at Birmingham 703 19th St South, ZRB 1034, Birmingham, AL 35294–0007 USA |
| Vlado Perkovic, MBBS, FRACP FASN, PhD Co–Director of the Renal Division |
George Institute for International Health, University of Sydney, PO Box M201, Missenden Road, Sydney, NSW 2050 AUSTRALIA |
| Cibele Isaac Saad Rodrigues, MD, PhD Professor of Nephrology Coordinator, Hypertension Department of Brazilian Society of Nephrology |
Catholic University of São Paulo (Pontifícia Universidade Católica de São Paulo - PUC-SP) BRAZIL |
| Mark J. Sarnak, MD, MS Associate Professor of Medicine Director of Research |
William B. Schwartz Division of Nephrology Tufts Medical Center, 800 Washington St., Box 391 Boston, MA 02111, USA |
| Guntram Schernthaner, MD Head of the Department of Medicine I |
Rudolfstiftung Hospital–Vienna Juchgasse 25 A – 1030 Vienna, AUSTRIA |
| Charles RV Tomson, DM, FRCP Consultant Renal Physician Chairman, UK Renal Registry Lead clinician, Safer Patients Initiative |
Department of Renal Medicine Southmead Hospital Bristol BS10 5NB UNITED KINGDOM |
| Carmine Zoccali, MD | Renal and Transplantation Unit and CNR-IBIM Clinical Research Unit, Ospedali Riuniti, 89125 Reggio Calabria ITALY |
Guideline Scope
The KDIGO Clinical Practice Guideline on Blood Pressure in CKD will build on the 2004 KDOQI Guideline on Hypertension and Antihypertensive Agents. We will also look into the existing guidelines by the International Society of Hypertension (ISH) and the World Health Organization (WHO). The progress of JNC8 will also be closely followed. Participants from each of these 3 groups (JNC8, ISH, and WHO) will be asked to join the KDIGO Work Group.
Systematic review of literature will be conducted to search for new evidence since the publication of 2004 KDOQI guidelines for the following specific topics:
- BP targets for CKD Stage 1–5 and CKD Stage 1–5T
- Antihypertensive agents for CKD Stage 1–5 and CKD Stage 1–5T
The Work Group will refer to the prior guideline for BP evaluation, BP measurement and for the evaluation of RAS. No systematic review will be conducted on the technical aspects of ABPM. No systematic review will be conducted for the treatment of Renal Artery Stenosis (RAS). The Work Group will cite a recent Evidence Practice Center report which compared angioplasty and medical treatment for RAS and reference the ASTRAL (completed) and CORAL (ongoing) studies.
For CKD 5D, the Work Group will summarize the KDIGO controversies conference paper on the topic and, if needed, will further clarify the state of science, current questions, areas of controversies and uncertainties, and make recommendations for future research. There will be no systematic review of studies in 5D.
Following criteria will apply for systematic review topics that are to be addressed in the guideline:
- Populations
- CKD 1–5, adults and children with or without hypertension
- CKD 1–5T: update RCTs on anti–hypertensive agents. Also, record the number of individuals on calcineurin inhibitors in these trials.
- Disease conditions: DKD (DM and CKD), Non–DKD, Cystic disease
- Include CKD subgroups of large “general population” studies
- Interventions
- Agent 1 vs. Agent 2
- BP Target 1 vs. BP Target 2
- Combination therapies
- Lifestyle modifications (salt restriction, weight loss, exercise, but not dietary supplements such as fish oil)
- Comparisons
- Active or placebo
- Outcomes
- Clinical cardiovascular events
- Change in Kidney function– continuous, categorical or slope of GFR (must provide baseline measurement)
- Change in Proteinuria – continuous, categorical (must provide baseline measurement)
- BP (only for lifestyle interventions)
- Adverse events, especially for drug specific adverse events (for ACEI and ARB: hyperkalemia, acute loss of kidney function, need for dose reduction or drug discontinuation)
- EXCLUDE: cardiovascular surrogates, or subclinical cardiac outcomes: i.e. PWV, central pulse pressure, LVH, LVMI or IMT
- Study Design
- RCTs with parallel group design
- Cross–over studies for lifestyle modification
- Minimum sample size of ≥50/arm
- Minimum duration of follow–up: 6 weeks for blood pressure, 3 months for proteinuria, 1 year for kidney function and clinical outcomes
- Years of publication: July 2001 forward
- For Pediatric population – data extract if studies meet above criteria. Tabulate and seek work group opinion for other RCTs.
Ongoing studies of ACCORD and SPRINT will also be watched closely for availability of results to be included in this guideline
.