The 2021 KDIGO blood pressure target and the progression of chronic kidney disease: Findings from KNOW‐CKD

Author:

Park Cheol Ho1ORCID,Kim Hyung Woo1,Park Jung Tak1ORCID,Chang Tae Ik2ORCID,Yoo Tae‐Hyun1,Park Sue Kyung3,Kim Yaeni4,Jung Ji Yong5ORCID,Jeong Jong Cheol6,Oh Kook‐Hwan7,Kang Shin‐Wook1,Han Seung Hyeok1ORCID,

Affiliation:

1. Department of Internal Medicine College of Medicine Institute of Kidney Disease Research Yonsei University Seoul Republic of Korea

2. Department of Internal Medicine National Health Insurance Service Medical Center, Ilsan Hospital Goyang Republic of Korea

3. Department of Preventive Medicine Seoul National University College of Medicine Seoul Republic of Korea

4. Department of Internal Medicine Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea

5. Division of Nephrology Department of Internal Medicine Gachon University Gil Medical Center Incheon Republic of Korea

6. Department of Internal Medicine Seoul National University Bundang Hospital Seongnam Republic of Korea

7. Department of Internal Medicine Seoul National University Hospital, Kidney Research Institute Seoul Republic of Korea

Abstract

AbstractBackgroundThe 2021 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline for the management of blood pressure (BP) in chronic kidney disease (CKD) recommends a target systolic BP of <120 mmHg as this target can provide cardiovascular benefits. However, it remains unclear whether implementing the new BP target could improve kidney outcomes.MethodsThe association between the 2021 KDIGO BP target and CKD progression was examined and compared with the 2012 KDIGO BP target among 1724 participants included in the KoreaN Cohort Study for Outcomes in Patients With CKD. The main exposure was the BP status categorized according to the 2012 or 2021 KDIGO guideline: (1) controlled within the 2021 target, (2) controlled within the 2012 target only, and (3) above both targets. The primary outcome was a composite kidney outcome of ≥50% decline in the estimated glomerular filtration rate from baseline or the initiation of kidney replacement therapy during the follow‐up period.ResultsComposite kidney outcomes occurred in 650 (37.7%) participants during the 8078 person‐years of follow‐up (median, 4.9 years). The incidence rates of this outcome were 55, 66.5, and 116.4 per 1000 person‐years in BP controlled within the 2021 and 2012 KDIGO targets, and BP above both targets, respectively. In the multivariable cause‐specific hazard model, hazard ratios for the composite outcome were 0.76 (95% confidence interval (CI), 0.60–0.95) for BP controlled within the 2021 target and 1.36 (95% CI, 1.13–1.64) for BP above both targets, compared with BP controlled within 2012 target only.ConclusionThe newly lowered BP target by the 2021 KDIGO guideline was associated with improved kidney outcome compared with BP target by the 2012 KDIGO guideline.

Funder

Korea Disease Control and Prevention Agency

Publisher

Wiley

Subject

Internal Medicine

Reference38 articles.

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