Commentary on the KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in CKD

Johannes F.E. Mann, Tara I. Chang, William C. Cushman, Susan L. Furth, Joachim H. Ix, Fan Fan Hou, Gregory A. Knoll, Paul Muntner, Roberto Pecoits-Filho, Mark J. Sarnak, Charles R.V. Tomson, Jonathan C. Craig, David J. Tunnicliffe, Martin Howell, Marcello Tonelli, Michael Cheung, Amy Earley, Alfred K. Cheung

Research output: Contribution to journalReview articlepeer-review


Purpose of Review: To summarize and explain the new guideline on blood pressure (BP) management in chronic kidney disease (CKD) published by Kidney Disease: Improving Global Outcomes (KDIGO), an independent global nonprofit organization which develops and implements evidence-based clinical practice guidelines in kidney disease. KDIGO issued its first clinical practice guideline for the Management of Blood Pressure (BP) in Chronic Kidney Disease (CKD) for patients not receiving dialysis in 2012 and now updated the guideline in 2021. Recent Findings: Recommendations in this update were developed based on systematic literature reviews and appraisal of the quality of the evidence and strength of recommendation following the “Grading of Recommendations Assessment, Development and Evaluation” (GRADE) approach. The updated guideline includes five chapters covering BP measurement techniques, lifestyle interventions for lowering BP, and management of BP in three target populations, namely adults (with and without diabetes), kidney transplant recipients, and children. A dedicated chapter on BP measurement emphasizing standardized preparation and measurement protocols for office BP measurement is a new addition, following protocols used in large randomized trials of BP targets with pivotal clinical outcomes. Summary: Based on the available evidence, and in particular in the CKD subgroup of the SPRINT trial, the 2021 guideline suggests a systolic BP target of <120 mm Hg, based on standardized measurements, for most individuals with CKD not receiving dialysis, with the exception of kidney transplant recipients and children. This recommendation is strictly contingent on the measurement of BP using standardized office readings and not routine office readings.

Original languageEnglish
Article number132
Number of pages9
JournalCurrent Cardiology Reports
Issue number9
Publication statusPublished - Sep 2021


  • Albuminuria
  • Angiotensin II receptor blocker
  • Angiotensin-converting enzyme inhibitor
  • Blood pressure measurement
  • Blood pressure targets
  • Children
  • Chronic kidney disease
  • Dietary sodium
  • Kidney transplant recipient
  • Standardized office blood pressure


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