Clinician Article

Management of Blood Pressure in Patients With Chronic Kidney Disease Not Receiving Dialysis: Synopsis of the 2021 KDIGO Clinical Practice Guideline.

  • Tomson CRV
  • Cheung AK
  • Mann JFE
  • Chang TI
  • Cushman WC
  • Furth SL, et al.
Ann Intern Med. 2021 Sep;174(9):1270-1281. doi: 10.7326/M21-0834. Epub 2021 Jun 22. (Review)
PMID: 34152826
Read abstract Read full text
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 7/7
    Newsworthiness - 7/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 7/7
    Newsworthiness - 7/7
  • Internal Medicine
    Relevance - 7/7
    Newsworthiness - 6/7
  • Nephrology
    Relevance - 7/7
    Newsworthiness - 5/7
  • Cardiology
    Relevance - 5/7
    Newsworthiness - 4/7


DESCRIPTION: The Kidney Disease: Improving Global Outcomes (KDIGO) 2021 clinical practice guideline for the management of blood pressure (BP) in patients with chronic kidney disease (CKD) not receiving dialysis is an update of the KDIGO 2012 guideline on the same topic and reflects new evidence on the risks and benefits of BP-lowering therapy among patients with CKD. It is intended to support shared decision making by health care professionals working with patients with CKD worldwide. This article is a synopsis of the full guideline.

METHODS: The KDIGO leadership commissioned 2 co-chairs to convene an international Work Group of researchers and clinicians. After a Controversies Conference in September 2017, the Work Group defined the scope of the evidence review, which was undertaken by an evidence review team between October 2017 and April 2020. Evidence reviews were done according to the Cochrane Handbook. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to guide the development of the recommendations and rate the strength and quality of the evidence. Practice points were included to provide guidance when evidence was insufficient to make a graded recommendation. The guideline was revised after public consultation between January and March 2020.

RECOMMENDATIONS: The updated guideline comprises 11 recommendations and 20 practice points. This synopsis summarizes key recommendations pertinent to the diagnosis and management of high BP in adults with CKD, excluding those receiving kidney replacement therapy. In particular, the synopsis focuses on recommendations for standardized BP measurement and a target systolic BP of less than 120 mm Hg, because these recommendations differ from some other guidelines.

Clinical Comments

Internal Medicine

There is detailed advice on managing HTN in patients with chronic kidney disease.

Internal Medicine

This is an important guideline for an uncertain area.


This is an important summary of practice guidelines on a very common problem in nephrology, from one of the key organizations that produce such guidelines.

Register for free access to all Professional content

Want the latest in aging research? Sign up for our email alerts.

Support for the Portal is largely provided by the Labarge Optimal Aging Initiative. AGE-WELL is a contributing partner. Help us to continue to provide direct and easy access to evidence-based information on health and social conditions to help you stay healthy, active and engaged as you grow older. Donate Today.

© 2012 - 2020 McMaster University | 1280 Main Street West | Hamilton, Ontario L8S4L8 | +1 905-525-9140 | Terms Of Use