[The KDIGO guideline on blood pressure management in chronic kidney disease is based on weak evidence]

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Clinical Guidelines

Background:

• The Kidney Disease Improving Global Outcomes (KDIGO) guideline recommends a systolic blood pressure (BP) target of <120 mm Hg for all adults with hypertension and chronic kidney disease (CKD).
• This recommendation has generated controversy due to its reliance on limited evidence, primarily from subgroup analyses of a single randomized controlled trial.

Purpose of the Study:

• To critically evaluate the KDIGO guideline's BP target recommendation for CKD patients.
• To present alternative BP management strategies for hypertension in CKD.

Main Methods:

• Review and analysis of the evidence underpinning the KDIGO guideline.
• Comparison of KDIGO recommendations with those from other major nephrology societies, such as the Swedish Society of Nephrology.

Main Results:

• The KDIGO guideline's <120 mm Hg systolic BP target is based on weak evidence.
• The Swedish Society of Nephrology suggests a BP target of <140/90 mm Hg for all CKD patients.
• A target of <130/80 mm Hg is recommended by the Swedish Society of Nephrology for most CKD patients, if treatment is well tolerated.

Conclusions:

• The <120 mm Hg systolic BP target recommended by KDIGO for CKD patients is controversial and lacks robust supporting evidence.
• Alternative BP targets, such as <140/90 mm Hg or <130/80 mm Hg, may be more appropriate for managing hypertension in CKD, depending on individual patient tolerance and response to treatment.