Executive summary of the KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease
Executive summary of the KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease
复制标题
DOI：
10.1016/j.kint.2020.10.026
复制
发表时间：
2021-02-23
影响因子：
19.6
通讯作者：
Mann, Johannes F. E.
中科院分区：
文献类型：
--
作者：
Cheung, Alfred K.;Chang, Tara, I;Mann, Johannes F. E.
《肾脏疾病：改善全球成果 (KDIGO) 2021 年针对未接受透析的慢性肾脏病患者血压管理的临床实践指南》是对 KDIGO 2012 年指南关于该主题的更新。本指南更新的制定遵循了严格的证据审查和评估过程。指南建议基于对相关研究的系统回顾和对证据质量的评估。建议的强度基于“建议评估、制定和评价分级”(GRADE) 方法。范围包括原始指南中涵盖的主题，例如最佳血压目标、生活方式干预、抗高血压药物以及肾移植受者和儿童的具体管理。一般健康和心血管健康的某些方面，例如血脂和吸烟管理，被排除在外。本指南还引入了专门讨论正确血压测量的章节，因为所有针对具有关键结果的血压的大型随机试验都使用患者和临床医生遵守的标准化准备和测量方案。根据之前和新的证据，特别是收缩压干预试验 (SPRINT) 结果，我们建议使用标准化办公室读数，将收缩压目标控制在 120 mm Hg 以下，适用于大多数未接受透析的慢性肾病 (CKD) 患者（儿童和肾移植受者除外）。本指南的目标是为临床医生和患者提供有用的资源，提供可操作的建议并辅以实践要点。考虑到建议对患者和资源的负担、公共政策影响以及证据的局限性。最后，提供了知识差距和对未来研究的建议。
The Kidney Disease: Improving Global Outcomes (KDIGO) 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease for patients not receiving dialysis represents an update to the KDIGO 2012 guideline on this topic. Development of this guideline update followed a rigorous process of evidence review and appraisal. Guideline recommendations are based on systematic reviews of relevant studies and appraisal of the quality of the evidence. The strength of recommendations is based on the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) approach. The scope includes topics covered in the original guideline, such as optimal blood pressure targets, lifestyle interventions, antihypertensive medications, and specific management in kidney transplant recipients and children. Some aspects of general and cardiovascular health, such as lipid and smoking management, are excluded. This guideline also introduces a chapter dedicated to proper blood pressure measurement since all large randomized trials targeting blood pressure with pivotal outcomes used standardized preparation and measurement protocols adhered to by patients and clinicians. Based on previous and new evidence, in particular the Systolic Blood Pressure Intervention Trial (SPRINT) results, we propose a systolic blood pressure target of less than 120 mm Hg using standardized office reading for most people with chronic kidney disease (CKD) not receiving dialysis, the exception being children and kidney transplant recipients. The goal of this guideline is to provide clinicians and patients a useful resource with actionable recommendations supplemented with practice points. The burden of the recommendations on patients and resources, public policy implications, and limitations of the evidence are taken into consideration. Lastly, knowledge gaps and recommendations for future research are provided.