(Brussels, Belgium) – – – Kidney Disease: Improving Global Guidelines (KDIGO) announced today the publication of its latest clinical practice guideline on the “Management of Blood Pressure in Chronic Kidney Disease.” This is the 8th guideline issued by KDIGO, a Belgian foundation in the public interest and the only organization developing and implementing global kidney disease guidelines.
The guideline is the culmination of an 18-month process during which relevant clinical trials, studies and data were given a rigorous structured review and presented to a 15 member work group that wrote the recommendations. KDIGO designs its guidelines to help individual practitioners and patients make informed clinical decisions about their care.
The work group was chaired by David Wheeler, MD, of London, also a Co-Chair of KDIGO, and Gavin Becker, MD, of Sydney. The guideline was published in Kidney International Supplements, a journal of the International Society of Nephrology. It is available in full text at www.kdigo.org.
“Managing blood pressure is critically important in patients with compromised kidney function. These people have a higher risk of cardiovascular events and premature death than the general population. Keeping their blood pressure within strict targets reduces those risks.” Dr. Wheeler said.
The guideline states that available evidence indicates that most kidney patients with mild to moderate kidney impairment without proteinuria should have a target blood pressure of 140 over 90. Those with albuminuria should attain a target blood pressure of 130 over 80. The recommendations are identical in patients with or without diabetes.
Dr. Wheeler added, “We recommend life style changes such as exercise and salt restriction along with multiple pharmaceutical agents. We also give special consideration to children, the elderly and those who have had a kidney transplant.”
KDIGO publishes global guidelines, holds conferences on controversial issues and has a network of official representatives in 86 countries working to implement its guidelines and conference recommendations. KDIGO is a self-managed patient centered not for profit organization. Its activities are funded through a consortium of companies and organizations who support the guidelines but have no ability to influence their recommendations.
“KDIGO uses a grid of risk factors developed for its guideline on classification of kidney disease, to pinpoint a patient’s level of risk,” said Dr. Becker. “Risk is assessed by level of kidney function and the presence of protein in the urine. The higher risk patients need a lower target. But, we found that most patients are fine with 140/90.”
He added, “Blood pressure is easy to check, costs nothing and adds a great deal to our ability to improve patient outcomes. We provided these recommendations to make it clearer to practitioner and patients that blood pressure at target levels is very beneficial.”
KDIGO’s guidelines are published only after a rigorous review by a scientific board with 50 members followed by a general public review. Only after all comments are taken into account are guidelines submitted for publication.
Dr. Bertram Kasiske, the other KDIGO Co-chair said, “We are very proud of our process. It seeks the broadest input and prevents any commercial or academic bias in the final guideline. We grade evidence and recommendations and note the strength of each. Global guidelines are important because science is global. We also focus a lot of effort on implementation because that is frequently local.”
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