24 Feb Chronic Kidney Disease: More Patients Would Benefit from Lower Blood Pressure Targets

MedicalResearch.com Interview with:
Kathryn Foti, PhD, MPH
Postdoctoral fellow
Department of Epidemiology
Johns Hopkins Bloomberg School of Public Health

MedicalResearch.com: What is the background for this study?

Response: The Kidney Disease: Improving Global Outcomes (KDIGO) 2021 Clinical Practice Guideline for the Management of Blood Pressure (BP) in Chronic Kidney Disease (CKD) provides recommendations for the management of BP in individuals with nondialysis CKD, incorporating new evidence since the publication of its previous guideline in 2012.

The 2021 KDIGO guideline recommends a target systolic BP <120 mmHg based on standardized office BP measurement. This BP goal is largely informed by the findings of the SPRINT trial which found targeting SBP <120 mmHg compared with <140 mmHg reduced the risk of cardiovascular disease by 25% and all-cause mortality by 27%. The benefits were similar for participants with and without CKD.

In our study, we sought to examine the potential implications of the 2021 KDIGO guideline for BP lowering among US adults with CKD compared to the 2012 KDIGO guideline (target BP ≤130/80 mmHg in adults with albuminuria or ≤140/90 mmHg or under without albuminuria) and the 2017 American College of Cardiology/American Heart Association (target BP <130/80 mmHg) guideline. Additionally, we determined implications of the 2021 KDIGO guideline for angiotensin converting enzyme inhibitor (ACEi) or angiotensin II-receptor blocker (ARB) use for those with albuminuria (recommended at systolic BP ≥120 mmHg) compared to the 2012 KDIGO guideline (recommended at BP >130/80 mmHg). 

MedicalResearch.com: What are the main findings?

Response: Based on data from the 2015-2018 National Health and Nutrition Examination Survey, we found that 69.5% of US adults with CKD (24.5 million) were eligible for blood pressure lowering according to the 2021 KDIGO guideline, compared with 49.8% (17.6 million) according 2012 KDIGO guideline or 55.6% (19.6 million) according to the 2017 American College of Cardiology/American Heart Association guideline. Among those with albuminuria, 78.2% were eligible for ACEi/ARB use by the 2021 KDIGO guideline compared with 71.0% by the 2012 KDIGO guideline. However, only 39.1% were taking an ACEi/ARB. 

MedicalResearch.com: What should readers take away from your report?

Response: Our findings highlight the need to improve diagnosis and awareness of CKD and appropriately treat high blood pressure  in such individuals. Based on the 2021 KDIGO guideline, nearly 70% of all US adults with CKD could potentially benefit from BP lowering and only half of those with albuminuria recommended an ACEi/ARB were taking one. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future research studies could examine uptake of the 2021 KDIGO guideline recommendations in clinical practice. 

MedicalResearch.com: Is there anything else you would like to add?

Response: Controlling blood pressure  is a public health priority and particularly important for the 1 in 7 US adults with CKD, a population with high cardiovascular disease risk. Because chronic kidney disease is so common, these new clinical guidelines could have a major public health impact.

Our author disclosures are listed in the article. 

Citation:

Potential Implications of the 2020 KDIGO Blood Pressure Guideline for U.S. Adults with Chronic Kidney Disease

VOLUME 99, ISSUE 3, P686-695, MARCH 01, 2021

Potential implications of the 2021 KDIGO blood pressure guideline for adults with chronic kidney disease in the United States

Kathryn E. Foti, Dan Wang, Alexander R. Chang, Tara I. Chang, Paul Muntner, Josef Coresh et al
Kidney International DOI:https://doi.org/10.1016/j.kint.2020.12.019

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Last Updated on February 24, 2021 by Marie Benz MD FAAD