Management Of Blood Pressure In Chronic Kidney Disease

Publication Date: December 1, 2012
Last Updated: March 14, 2022

Recommendation Statements

Lifestyle and pharmacological treatments for lowering blood pressure in CKD ND patients

GENERAL STRATEGIES

Individualize BP targets and agents according to age, co-existent cardiovascular disease and other co-morbidities, risk of progression of CKD, presence or absence of retinopathy (in CKD patients with diabetes) and tolerance of treatment. (NG)
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Inquire about postural dizziness and check for postural hypotension regularly when treating CKD patients with BP-lowering drugs. (NG)
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LIFESTYLE MODIFICATION

Encourage lifestyle modification in patients with CKD to lower BP and improve long-term cardiovascular and other outcomes:
  • We recommend achieving or maintaining a healthy weight (BMI 20 to 25).
(Level 1, D)
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  • We recommend lowering salt intake to <90 mmol (<2 g) per day of sodium (corresponding to 5 g of sodium chloride), unless contraindicated.
(Level 1, C)
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  • We recommend undertaking an exercise program compatible with cardiovascular health and tolerance, aiming for at least 30 minutes 5 times per week.
(Level 1, D)
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  • We suggest limiting alcohol intake to no more than two standard drinks per day for men and no more than one standard drink per day for women.
(Level 2, D)
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Blood pressure management in CKD ND patients without diabetes mellitus

We recommend that non-diabetic adults with CKD ND and urine albumin excretion <30 mg per 24 hours (or equivalent) whose office BP is consistently >140 mm Hg systolic or >90 mm Hg diastolic be treated with BP-lowering drugs to maintain a BP that is consistently ≤140 mm Hg systolic and ≤90 mm Hg diastolic. (Level 1, B)
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We suggest that non-diabetic adults with CKD ND and urine albumin excretion of 30 to 300 mg per 24 hours (or equivalent) whose office BP is consistently ≥130 mm Hg systolic or ≥80 mm Hg diastolic be treated with BP-lowering drugs to maintain a BP that is consistently <130 mm Hg systolic and <80 mm Hg diastolic. (Level 2, D)
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We suggest that non-diabetic adults with CKD ND and urine albumin excretion >300 mg per 24 hours (or equivalent) whose office BP is consistently >130 mm Hg systolic or >80 mm Hg diastolic be treated with BP-lowering drugs to maintain a BP that is consistently ≤130 mm Hg systolic and ≤80 mm Hg diastolic. (Level 2, C)
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We suggest that an ARB or ACE-I be used in non-diabetic adults with CKD ND and urine albumin excretion of 30 to 300 mg per 24 hours (or equivalent) in whom treatment with BP-lowering drugs is indicated. (Level 2, D)
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We recommend that an ARB or ACE-I be used in non-diabetic adults with CKD ND and urine albumin excretion >300 mg per 24 hours (or equivalent) in whom treatment with BP-lowering drugs is indicated. (Level 1, B)
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Blood pressure management in CKD ND patients with diabetes mellitus

We recommend that adults with diabetes and CKD ND with urine albumin excretion <30 mg per 24 hours (or equivalent) whose office BP is consistently >140 mm Hg systolic or >90 mm Hg diastolic be treated with BPlowering drugs to maintain a BP that is consistently <140 mm Hg systolic and <90 mm Hg diastolic. (Level 1, B)
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We suggest that adults with diabetes and CKD ND with urine albumin excretion 430 mg per 24 hours (or equivalent) whose office BP is consistently >130 mm Hg systolic or >80 mm Hg diastolic be treated with BP-lowering drugs to maintain a BP that is consistently <130 mm Hg systolic and <80 mm Hg diastolic. (Level 2, D)
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We suggest that an ARB or ACE-I be used in adults with diabetes and CKD ND with urine albumin excretion of 30 to 300 mg per 24 hours (or equivalent). (, )
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We recommend that an ARB or ACE-I be used in adults with diabetes and CKD ND with urine albumin excretion >300 mg per 24 hours (or equivalent). (Level 1, B)
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Blood pressure management in kidney transplant recipients (CKD T)

We suggest that adult kidney transplant recipients whose office BP is consistently >130 mm Hg systolic or >80 mm Hg diastolic be treated to maintain a BP that is consistently ≤130 mm Hg systolic and ≤80 mm Hg diastolic, irrespective of the level of urine albumin excretion. (Level 2, D)
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In adult kidney transplant recipients, choose a BP-lowering agent after taking into account the time after transplantation, use of calcineurin inhibitors, presence or absence of persistent albuminuria, and other co-morbid conditions. (NG)
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Blood pressure management in children with CKD ND

We recommend that in children with CKD ND, BP-lowering treatment is started when BP is consistently above the 90th percentile for age, sex, and height. (Level 1, C)
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We suggest that in children with CKD ND (particularly those with proteinuria), BP is lowered to consistently achieve systolic and diastolic readings less than or equal to the 50th percentile for age, sex, and height, unless achieving these targets is limited by signs or symptoms of hypotension. (Level 2, D)
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We suggest that an ARB or ACE-I be used in children with CKD ND in whom treatment with BP-lowering drugs is indicated, irrespective of the level of proteinuria. (Level 2, D)
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Blood pressure management in elderly persons with CKD ND

Tailor BP treatment regimens in elderly patients with CKD ND by carefully considering age, co-morbidities and other therapies, with gradual escalation of treatment and close attention to adverse events related to BP treatment, including electrolyte disorders, acute deterioration in kidney function, orthostatic hypotension and drug side effects. (NG)
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Recommendation Grading

Overview

Title

Management of Blood Pressure in Chronic Kidney Disease

Authoring Organization

Publication Month/Year

December 1, 2012

Last Updated Month/Year

February 7, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Dietician nutritionist, nurse, nurse practitioner, physician, physician assistant

Scope

Counseling, Management, Treatment

Diseases/Conditions (MeSH)

D006973 - Hypertension, D001794 - Blood Pressure, D007674 - Kidney Diseases, D007673 - Kidney Cortex Necrosis

Keywords

blood pressure, chronic kidney disease

Source Citation

Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney inter., Suppl. 2012; 2: 337–414.

Supplemental Methodology Resources

Data Supplement, Data Supplement, Methodology Supplement

Methodology

Number of Source Documents
453
Literature Search Start Date
January 1, 2011
Literature Search End Date
February 1, 2012