Commentary on the 2021 update of the KDIGO clinical practice guideline for management of blood pressure in chronic kidney disease

The 2021 KDIGO clinical practice guideline for the management of blood pressure (BP) in chronic kidney disease (CKD) provided significant practice-changing recommendations for the care of both adult and paediatric CKD patients not receiving dialysis. The purpose of this review is to contextualise these recommendations and evaluate their applicability to the Australian and New Zealand context. Key updates presented in this guideline relate to measurement techniques, with a strong recommendation for standardised office BP measurement, as opposed to routine office BP measurement. Standardised measurement is more nuanced, compared to routine measurement, in terms of patient preparation, technique, timing, and duration of measurement, which may produce more accurate measurements but may require restructuring of clinical appointments and retraining of staff. The target systolic BP level for non-dialysis, non-transplant adult CKD patients suggested is <120 mmHg. The lifestyle and pharmacological interventions for lowering BP include regular exercise, a low-sodium diet, and renin-angiotensin-system (RAS) inhibitors in patients with comorbid diabetes or albuminuria. This commentary identifies several patient subgroups requiring further investigation and clinical guidance, including diabetic CKD, dialysis and transplant recipients with CKD, and paediatric CKD, and highlights the importance of further exploring the effect of SGLT2 inhibitors on high BP in CKD patients.