To assess publication bias, we used funnel plots of the log odds ratio (effect vs. standard error of the effect size) when a suf cient number of studies were Other reasons for the asymmetry of funnel plots were considered. Subgroup analysis and investigation of heterogeneity. Subgroup analysis was undertaken to explore whether there were clinical dif- ferences between the studies that may have systematically in uenced the differences that were observed in the critical and important outcomes. However, subgroup analyses are hypothesis-forming rather than hypothesis-testing and should be interpreted with caution. The following subgroups were considered: severity of CKD, primary kidney disease, elderly age/presence of comorbidities, presence of proteinuria or albuminuria, diabetes, number of antihypertensives, lifestyle behaviors/health behaviors. The test of subgroup differences used the I2 statistic and a P value of 0.1 (noting that this is a weak test).383 Sensitivity analysis. The following sensitivity analyses were considered: Table 1| Hierarchy of outcomes Hierarchy Outcomes Critical outcomes  All-cause mortality  Cardiovascular mortality  Kidney failure (formerly known as ESKD)  Cardiovascular events (MI, stroke, HF)  Dementia or cognitive impairment Important outcomes  Doubling serum creatinine  AKI  Falls  Fatigue  Body weight  Blood pressure Outcomes of limited importance  eGFR or creatinine clearance  Proteinuria AKI, acute kidney injury; eGFR, estimated glomerular ltration rate; ESKD, end-stage kidney disease; HF, heart failure; MI, myocardial infarction. The critical and important outcomes were voted on by the Work Group using an adapted Delphi process (1 9 Likert scale). Critical outcomes median was rated 7 9, and important outcomes were rated 4 6 on the 9-point scale.


Critical outcomes median was rated 7 9, and important outcomes were rated 4 6 on the 9-point scale. www.kidney-international.org methods for guideline development Table 2| Clinical questions and systematic review topics in the PICOM format Guideline Chapter 1 Blood pressure measurement Clinical question In patients with CKD, what is the diagnostic accuracy of various BP measurement techniques compared to standardized auscultatory of ce-based BP? Population Patients with CKD (CKD G1 G5 without kidney transplant, and kidney transplant recipients) Index test Oscillometric (of ce-based) BP (unattended or attended), ambulatory BP, home oscillometric monitors Reference standard Auscultatory of ce-based BP monitoring Outcomes Sensitivity, speci city, negative predictive value, positive predictive value Study design Systematic reviews SoF table Supplementary Table S41 Clinical question In the general population, what is the diagnostic accuracy of various BP measurement techniques (oscillometric of ce and home BP, ambulatory BP) compared to standardized auscultatory of ce-based BP in diagnosing high BP? Population General population Index test Oscillometric (of ce-based) BP (unattended or attended), ambulatory BP, home oscillometric monitors Reference standard Auscultatory of ce-based BP monitoring Outcomes Sensitivity, speci city, negative predictive value, positive predictive value Study design Systematic reviews SoF table Supplementary Tables S4, S42, and S43 Clinical question In the general population, what is the association among various approaches to measuring BP including in the clinic (standardized vs. non-standardized), at home, and ambulatory with classi cation of BP and long-term outcomes?


Population General population Index test Oscillometric (of ce-based) BP (unattended or attended), ambulatory BP, home oscillometric monitors Reference standard Auscultatory of ce-based BP monitoring Outcomes Sensitivity, speci city, negative predictive value, positive predictive value Study design Systematic reviews SoF table Supplementary Tables S4, S42, and S43 Clinical question In the general population, what is the association among various approaches to measuring BP including in the clinic (standardized vs. non-standardized), at home, and ambulatory with classi cation of BP and long-term outcomes? Population General population Index test Oscillometric (of ce-based) BP (unattended or attended), ambulatory BP, home oscillometric monitors Reference standard Auscultatory of ce-based BP monitoring Outcomes Cost-effectiveness Study design Systematic reviews SoF table Supplementary Tables S43 and S44 Guideline Chapter 2 Lifestyle interventions for lowering blood pressure in patients with CKD not receiving dialysis Clinical question In adults with CKD without diabetes, does reducing protein intake compared to usual protein intake improve clinically relevant outcomes and decrease adverse effects? Population Adults with CKD (CKD G1 G5 without kidney transplant) without diabetes Intervention Low-protein diet Comparator Usual-protein diet Outcomes Outcomes listed in Table 1 Study design RCTs Cochrane review Hahn D, et al. Low protein diets for non-diabetic adults with chronic kidney disease (Review). Cochrane Database of Systematic Reviews. 2020:10;CD001892.378 SoF table Supplementary Tables S49 and S50 Clinical question In adults with CKD without diabetes, does reducing dietary salt intake compared to usual dietary salt intake improve clinically relevant outcomes and decrease adverse effects? Population Adults with CKD (CKD G1 G5 without kidney transplant) without diabetes Intervention Low-salt diet Comparator Usual salt diet Outcomes Outcomes listed in Table 1 Additional outcomes sodium excretion, serum creatinine, BP Study design RCTs Cochrane review McMahon EJ, et al. Altered dietary salt intake for people with chronic kidney disease (Review).


Altered dietary salt intake for people with chronic kidney disease (Review). Cochrane Database of SoF table Supplementary Table S5 Clinical question In adults with CKD and diabetes, does reducing dietary salt intake compared to usual dietary salt intake improve clinically relevant outcomes and decrease adverse effects? Population Adults with CKD (CKD G1 G5 without kidney transplant) and diabetes (T1D and T2D) Intervention Low-salt diet Comparator Usual salt diet Outcomes Outcomes listed in Table 1 Additional outcomes body mass index Study design RCTs Cochrane review No relevant Cochrane Kidney and Transplant review SoF table Supplementary Tables S6 S9, S45, and S46 Clinical question What are the bene ts and harms of dietary interventions/patterns among adults with CKD, including people with kidney failure treated with kidney transplantation? Population Adults with CKD (CKD G1 G5 including kidney transplant recipient) Intervention Dietary modi cations (including dietary advice or lifestyle management) methods for guideline development www.kidney-international.org Guideline Chapter 2 Lifestyle interventions for lowering blood pressure in patients with CKD not receiving dialysis Comparator Standard of care (including lifestyle advice) or any other dietary pattern Outcomes Outcomes listed in Table 1 Additional outcomes BP Study design RCTs Cochrane review Palmer SC, et al. Dietary interventions for adults with chronic kidney disease. Cochrane Database of Systematic Reviews. SoF table Supplementary Tables S51 S53 and S90 Clinical question In adults with CKD and hypertension, does exercise improve clinically relevant outcomes and decrease adverse effects? Population Adults with CKD (CKD G1 G5 without kidney transplant) and high BP Intervention Any exercise intervention greater than 8 weeks duration (to examine the effects of regular ongoing physical exercise training) Comparator Standard of care Outcomes Outcomes listed in Table 1 Additional outcomes fat mass, BP, quality of life Study design RCTs Cochrane review Heiwe S and Jacobson SH.


Population Adults with CKD (CKD G1 G5 without kidney transplant) and high BP Intervention Any exercise intervention greater than 8 weeks duration (to examine the effects of regular ongoing physical exercise training) Comparator Standard of care Outcomes Outcomes listed in Table 1 Additional outcomes fat mass, BP, quality of life Study design RCTs Cochrane review Heiwe S and Jacobson SH. Exercise training for adults with chronic kidney disease (Review). Cochrane Database of Systematic Reviews. 2011:10;CD00323.380 SoF table Supplementary Tables S10, S47, and S48 Guideline Chapter 3 Blood pressure management in patients with CKD, with or without diabetes, not receiving dialysis Clinical question In patients with CKD, does lower (intensive) BP targets compared to standard BP targets improve clinical ef cacy outcomes and reduce adverse effects? Population Adults with CKD (CKD G1 G5 without kidney transplant) and with or without diabetes (T1D and T2D) Intervention Lower BP target (<140/80 mm Hg, <130/80 mm Hg, <120 mm Hg, MAP <92 mm Hg target) Comparator Standard BP target (including MAP target 102 107 mm Hg) Outcomes Critical and important outcomes listed in Table 1 Study design RCTs Cochrane review None relevant SoF table Supplementary Tables S11 S14, S54 S59, and S75 S78 Clinical question In patients with CKD, does RAS inhibition compared to placebo/no treatment or standard of care improve clinical ef cacy outcomes and reduce adverse effects? Population Adults with CKD (CKD G1 G5 without kidney transplant) and with and without diabetes (T1D and T2D) Intervention ACEi, ARB, aldosterone antagonists Comparator Placebo/standard of care Outcomes Critical and important outcomes listed in Table 1 Study design RCTs Cochrane review Strippoli GFM, et al. Angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists for preventing the progression of diabetic kidney disease. Cochrane Database of Systematic Reviews. 2006:4;CD006257.259 Sharma P, et al.


Cochrane Database of Systematic Reviews. 2006:4;CD006257.259 Sharma P, et al. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for adults with early (stage 1 to 3) non-diabetic chronic kidney disease. Cochrane Database of Systematic Reviews. 2011:10;CD007751.281 Chung EYM, Ruospo M, Natale P, et al. Aldosterone antagonists in addition to renin angiotensin system antagonists for preventing the progression of chronic kidney disease. Cochrane Database of Systematic Reviews. 2020;10:CD007004.193 SoF table Supplementary Tables S15 S17, S21 S24, and S60 S62 Clinical question In patients with CKD, does non-RAS inhibition compared to placebo or RAS inhibition improve clinical ef cacy outcomes and reduce adverse effects? Population Adults with CKD (CKD G1 G5 without kidney transplant) and with and without diabetes (T1D and T2D) Intervention Non-RAS inhibition (alpha-blockers, beta-blockers, CCBs, DRIs, diuretics) Comparator Placebo or RASi Outcomes Critical and important harms listed in Table 1 Study design RCTs Cochrane review None relevant Clinical question In patients with CKD, does dual-RAS inhibition compared to mono-RAS inhibition improve clinical ef cacy outcomes and reduce adverse effects? Population Adults with CKD (CKD G1 G5 without kidney transplant) and with and without diabetes (T1D and T2D) Intervention Dual RAS inhibition Comparator Mono RAS inhibition Outcomes Critical and important harms listed in Table 1 Study design RCTs Cochrane review Strippoli GFM, et al. Angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists for preventing the progression of diabetic kidney disease. Cochrane Database of Systematic Reviews. 2006:4;CD006257.259 Sharma P, et al. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for adults with early (stage 1 to 3) non-diabetic chronic kidney disease. Cochrane Database of Systematic Reviews.


Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for adults with early (stage 1 to 3) non-diabetic chronic kidney disease. Cochrane Database of Systematic Reviews. 2011:10;CD007751.281 (Continued on following page) Table 2| (Continued) Clinical questions and systematic review topics in the PICOM format www.kidney-international.org methods for guideline development Guideline Chapter 3 Blood pressure management in patients with CKD, with or without diabetes, not receiving dialysis SoF table Supplementary Tables S31, S32, and S80 Clinical question In patients with CKD and chronic hyperkalemia, do potassium binders compared to placebo or standard of care improve clinically relevant outcomes, and decrease adverse effects? Population Adults with CKD (CKD G1 G5 without kidney transplant) with chronic hyperkalemia Intervention Potassium binders Comparator Placebo/standard of care Outcomes Critical and important harms listed in Table 1 Additional outcomes reported hospitalization, hypokalemia, SBP, and DBP Study design RCTs Cochrane review Natale P, et al. 2020. Potassium binders for chronic hyperkalaemia in people with chronic kidney disease. Cochrane Database of Systematic Reviews. 2020:6:CD013165.381 SoF table Supplementary Tables S73, S74, and S88 Guideline Chapter 4 Blood pressure management in kidney transplant recipients Clinical question In kidney transplant recipients, does reducing protein intake compared to usual protein intake improve clinically relevant outcomes and decrease adverse effects? Population Kidney transplant recipients Intervention Low-protein diet Comparator Usual protein diet Outcomes Outcomes listed in Table 1 Study design RCTs Cochrane review None relevant SoF table None Clinical question In kidney transplant recipients, does reducing dietary salt intake compared to usual salt intake improve clinically relevant outcomes and decrease adverse effect?


Population Kidney transplant recipients Intervention Low-protein diet Comparator Usual protein diet Outcomes Outcomes listed in Table 1 Study design RCTs Cochrane review None relevant SoF table None Clinical question In kidney transplant recipients, does reducing dietary salt intake compared to usual salt intake improve clinically relevant outcomes and decrease adverse effect? Population Kidney transplant recipients Intervention Low-salt diet Comparator Usual salt diet Outcomes Outcomes listed in Table 1 Additional outcomes sodium excretion, serum creatinine, BP Study design RCTs Cochrane review None relevant SoF table Supplementary Table S89 Clinical question What are the bene ts and harms of dietary interventions/patterns among kidney transplant recipients? Population Kidney transplant recipients Intervention Dietary modi cations (including dietary advice or lifestyle management) Comparator Standard of care (including lifestyle advice) or any other dietary pattern Outcomes Outcomes listed in Table 1 Additional outcomes BP Study design RCTs Cochrane review Palmer SC, et al. Dietary interventions for adults with chronic kidney disease. Cochrane Database of Systematic Reviews. SoF table Supplementary Table S90 Clinical question In kidney transplant recipients and high BP, does exercise improve clinically relevant outcomes and decrease adverse effects? Population Kidney transplant recipients and high BP Intervention Any exercise intervention greater than 8 weeks duration (to examine the effects of regular ongoing physical exercise training) Comparator Standard of care Outcomes Outcomes listed in Table 1 Additional outcomes body mass index, BP, quality of life Study design RCTs Cochrane review Heiwe S and Jacobson SH. Exercise training for adults with chronic kidney disease (Review). Cochrane Database of Systematic Reviews. 2011:10;CD00323.380 SoF table Supplementary Table S91 Clinical question In kidney transplant recipients does lower (intensive) BP target compared to standard BP targets improve clinical ef cacy outcomes and reduce adverse effects?


2011:10;CD00323.380 SoF table Supplementary Table S91 Clinical question In kidney transplant recipients does lower (intensive) BP target compared to standard BP targets improve clinical ef cacy outcomes and reduce adverse effects? Population Kidney transplant recipients, adult and children Intervention Lower BP target Comparator Standard BP target Outcomes Critical and important outcomes listed in Table 1 Study design RCTs Table 2| (Continued) Clinical questions and systematic review topics in the PICOM format methods for guideline development www.kidney-international.org  Repeating the analysis, excluding unpublished studies  Repeating the analysis taking account of the risk of bias, as speci ed  Repeating the analysis, excluding any very long or large studies to establish how much they dominate the results  Repeating the analysis, excluding studies using the following l- ters: language of publication, source of funding (industry vs. other), and country in which the study was conducted. However, the available data were insuf cient to determine the in u- ence of these factors on the effect size of critical and important outcomes. Grading the quality of the evidence and the strength of a guideline recommendation. GRADING the quality of the evidence for each outcome across studies. The overall quality of the evidence related to each critical and important outcome was assessed using the GRADE approach,384,388 which assesses the quality of the evidence for each outcome. For outcomes that are based on data from RCTs, the initial grade for the quality of the evidence is considered to be high. For observational studies, the initial quality of the evidence is low.


For observational studies, the initial quality of the evidence is low. The quality of the evidence is lowered in the event of study limitations; important inconsistencies in results across Guideline Chapter 4 Blood pressure management in kidney transplant recipients Cochrane review None relevant SoF table None Clinical question In kidney transplant recipients, what antihypertensive agents improve ef cacy outcomes and reduce adverse effects? Population Kidney transplant recipients, adult and children Intervention RAS inhibition (ACEi, ARB, aldosterone antagonists), and non-RAS inhibition (alpha-blockers, beta-blockers, CCBs, diuretics, DRI) Comparator Placebo or standard of care Outcomes Critical and important outcomes listed in Table 1 Other outcomes reported: BP Study design RCTs Cochrane review Cross NB, et al. Antihypertensive treatment for kidney transplant recipients. Cochrane Database of Systematic Reviews. SoF table Supplementary Tables S33 S39 and S92 S106 Clinical question In kidney transplant recipients with chronic hyperkalemia, do potassium binders compared to placebo or standard of care improve clinically relevant outcomes and decrease adverse effects? Population Kidney transplant recipients with chronic hyperkalemia Intervention Potassium binders Comparator Placebo/standard of care Outcomes Critical and important harms listed in Table 1 Study design RCTs Cochrane review Natale P, et al. 2020. Potassium binders for chronic hyperkalaemia in people with chronic kidney disease. Cochrane Database of Systematic Reviews. 2020:6:CD013165.381 SoF table None Guideline Chapter 5 Blood pressure management in children with CKD Clinical question In children with CKD, does a lower BP target compared to a higher BP target improve ef cacy outcomes and reduce adverse effects?


2020:6:CD013165.381 SoF table None Guideline Chapter 5 Blood pressure management in children with CKD Clinical question In children with CKD, does a lower BP target compared to a higher BP target improve ef cacy outcomes and reduce adverse effects? Population Children with CKD Intervention Lower BP target Comparator Standard BP target Outcomes Critical and important outcomes listed in Table 1 Study design RCTs Cochrane review None relevant SoF table Supplementary Table S40 Clinical question In children with CKD, what antihypertensive agents compared to standard of care improve ef cacy outcomes and reduce adverse effects? Population Children with CKD (CKD G1 G5 without kidney transplant and kidney transplant recipients) and diabetes (T1D and T2D) Intervention RAS inhibition (ACEi, ARB, aldosterone antagonists), and non-RAS inhibition (alpha-blockers, beta-blockers, CCBs, diuretics, DRI) Comparator Placebo or standard of care Outcomes Critical and important outcomes listed in Table 1 Additional outcomes: BP, serum creatinine Study design RCTs Cochrane review Bagga A, et al. Antihypertensive agents for children with chronic kidney disease (Protocol). Cochrane Database of Systematic SoF table Supplementary Table S107 ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; BP, blood pressure; CCB, calcium channel blocker; CKD, chronic kidney disease; DBP, diastolic blood pressure; DRI, direct renin inhibitor; MAP, mean arterial pressure; RAS(i), renin-angiotensin system (inhibitor); RCT, randomized controlled trial; SBP, systolic blood pressure; SoF, summary of ndings; T1D, type 1 diabetes; T2D, type 2 diabetes. Table 2| (Continued) Clinical questions and systematic review topics in the PICOM format www.kidney-international.org methods for guideline development studies; indirectness of the results, including uncertainty about the population, intervention, and outcomes measured in trials and their applicability to the clinical question of interest; imprecision in the evidence review results; and concerns about publication bias.


Table 2| (Continued) Clinical questions and systematic review topics in the PICOM format www.kidney-international.org methods for guideline development studies; indirectness of the results, including uncertainty about the population, intervention, and outcomes measured in trials and their applicability to the clinical question of interest; imprecision in the evidence review results; and concerns about publication bias. For imprecision, data were benchmarked against optimal information size, low event rates in either arm, CIs that indicate appreciable bene t and harm (25% decrease and 25% increase in the outcome of interest), and sparse data (only 1 study), all indicating concerns about the precision of the results.388 The nal grade for the quality of the evidence for an outcome could be high, moderate, low, or very low (Table 3). For observational studies and other study types, it is possible for the quality of the evidence to be upgraded from a rating of low quality, according to the speci ed criteria. For further details on the GRADE approach for rating quality of the evidence, see Table 4. Summary of ndings (SoF) tables. The SoF tables were developed to include a description of the population and the intervention and comparator. In addition, the SoF tables included results from the data synthesis as relative and absolute effect estimates. The grading of the quality of the evidence for each critical and important outcome is also provided in the SoF table. The SoF tables were generated using MAGICapp, an online software application designed to support guideline development, and they are available in the Data Supplement Appendix C and Appendix D (https://kdigo.org/ guidelines/blood-pressure-in-ckd/). Developing the recommendations. The recommendations were drafted by the Work Group Co-Chairs and Work Group members. Recommendations were revised in a multistep process during a face-to-face meeting (New Orleans, LA, USA, January 2019) and by e-mail communication.


Recommendations were revised in a multistep process during a face-to-face meeting (New Orleans, LA, USA, January 2019) and by e-mail communication. The nal draft was sent for external public review, and reviewers provided open-ended responses. Based on the external stakeholder feedback, the draft was further revised by Work Group Co-Chairs and members. All Work Group members provided feedback on initial and nal drafts of the recommendation statement and guideline text and approved the nal version of the guideline. The ERT also provided a descriptive Primary evidence Search October 2018, updated September 2019, updated April 2020 Cochrane Kidney and Transplant Registry, MEDLINE, Embase - 6156 study reports retrieved - 148 observational studies Included RCTs Dietary protein 21 RCTs Dietary and supplementary salt 30 RCTs Dietary patterns 5 RCTs Exercise interventions 11 RCTs Blood pressure targets in CKD 11 RCTs Renin angiotensin system inhibitors in adults 76 RCTs Non-renin angiotensin system inhibitors 37 RCTs Blood pressure targets in transplant recipients 1 RCT Antihypertensive therapy in transplant recipients 82 RCTs Blood pressure targets in children 1 RCT Antihypertensive therapy in children 2 RCTs Potassium binders 13 RCTs Included studies 290 RCTs (n 61000) Systematic reviews - 7 CKD narrative reviews - 3 general population diagnostic test accuracy reviews - 20 general population narrative reviews - 5 general population cost-effectiveness reviews 14 observational studies Full-text screening 524 citations excluded Systematic reviews of blood pressure measurement techniques Search February 2019, updated April 2020 Cochrane Kidney and Transplant Registry - 559 reports retrieved Figure 8 | Search yield and study ow diagram. CKD, chronic kidney disease; RCT, randomized controlled trial. Table 3| Classi cation for certainty and quality of the evidence Grade Quality of evidence Meaning A High We are con dent that the true effect is close to the estimate of the effect.


Table 3| Classi cation for certainty and quality of the evidence Grade Quality of evidence Meaning A High We are con dent that the true effect is close to the estimate of the effect. B Moderate The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. C Low The true effect may be substantially different from the estimate of the effect. D Very low The estimate of effect is very uncertain, and often it will be far from the true effect. methods for guideline development www.kidney-international.org summary of the evidence quality in support of the recommendations. Grading the strength of the recommendations. The strength of a recommendation is graded as strong or weak (Table 5). The strength of a recommendation was determined by the balance of bene ts and harms across all critical and important outcomes, the grading of the overall quality of evidence, patient preferences and values, resources, and other considerations (Table 6). Balance of bene ts and harms. The Work Group and ERT determined the anticipated net health bene t on the basis of expected bene ts and harms across all critical and important out- comes from the underlying evidence review. In addition to the evi- dence review, the ERT assisted Work Group members in evaluating the balance of bene ts and harms arising from key individual studies. The overall quality of evidence. The overall quality of the evidence was based on the certainty of the evidence for all critical and important outcomes, taking into account the relative importance of each outcome to the population of interest. The overall quality of the evidence was graded A, B, C, or D (Table 3).


The overall quality of the evidence was graded A, B, C, or D (Table 3). Table 4| GRADE system for grading quality of evidence Study design Starting grade of the quality of the evidence Step 2 Lower grade Step 3 Raise grade for observational studies RCTs High Study limitations: 2, very serious Strength of association: 1, large effect size (e.g., <0.5 or >2) 2, very large effect size (e.g., <0.2 or >5) Moderate Inconsistency: 2, very serious Evidence of a dose response gradient Observational studies Low Indirectness: 2, very serious All plausible confounding would reduce the demonstrated effect Very low Imprecision: 2, very serious Publication bias: 2, very serious GRADE, Grading of Recommendations Assessment, Development and Evaluation; RCT, randomized controlled trial. Table 5| KDIGO nomenclature and description for grading recommendations Grade Implications Patients Clinicians Policy Level 1 Strong We recommend Most people in your situation would want the recommended course of action, and only a small proportion would not. Most patients should receive the recommended course of action. The recommendation can be evaluated as a candidate for developing a policy or a performance measure. Level 2 Weak We suggest The majority of people in your situation would want the recommended course of action, but many would not. Different choices will be appropriate for different patients. Each patient needs help to arrive at a management decision consistent with her or his values and preferences. The recommendation is likely to require substantial debate and involvement of stakeholders before policy can be determined. Table 6| Determinants of the strength of recommendation Factors Comment Balance of bene ts and harms The larger the difference between the desirable and undesirable effects, the more likely a strong recommendation is provided. The narrower the gradient, the more likely a weak recommendation is warranted.


The narrower the gradient, the more likely a weak recommendation is warranted. Quality of evidence The higher the quality of evidence, the more likely a strong recommendation is warranted. However, there are exceptions for which low or very low quality of the evidence will warrant a strong recommendation. Values and preferences The more variability in values and preferences, or the more uncertainty in values and preferences, the more likely a weak recommendation is warranted. Values and preferences were obtained from the literature, where possible, or were assessed by the judgment of the Work Group when robust evidence was not identi ed. Resources and other considerations The higher the costs of an intervention that is, the more resources consumed the less likely a strong recommendation is warranted. www.kidney-international.org methods for guideline development Patient preferences and values. No patients or caregivers were involved in the Work Group. The Work Group, from their experi- ence in managing BP in patients with CKD and their understanding of the best available scienti c literature, made judgments on the preferences and values of patients. Formal qualitative evidence syn- thesis on patient priorities and preferences was not undertaken. Resources and other considerations. Healthcare and non- healthcare resources, including all inputs in the treatment were considered in grading the strength of a recommendation. The following resources were considered: direct healthcare costs, non-healthcare resources (e.g., transportation and social services), informal caregiver resources (e.g., time of family and caregivers), and changes in productivity. Economic evaluations, including cost-effectiveness analysis, were not conducted for any of the guideline topics. However, the ERT conducted searches for systematic reviews of cost-effectiveness studies in support of selected topics, such as BP measurement techniques.


However, the ERT conducted searches for systematic reviews of cost-effectiveness studies in support of selected topics, such as BP measurement techniques. Practice points In addition to graded recommendations, KDIGO guidelines now include practice points to help clinicians better evaluate and implement the guidance from the expert Work Group. Practice points are consensus statements about a speci c aspect of care, and they supplement recommendations for which a larger quantity of evidence was identi ed. These were used when no formal systematic evidence review was undertaken, or there was insuf cient evidence to provide a graded recommendation. Practice points represent the expert judg- ment of the guideline Work Group, but they also may be based on limited evidence. Practice points were sometimes formatted as a table, a gure, or an algorithm to make them easier to use in clinical practice. Format for guideline recommendations Each guideline recommendation provides an assessment of the strength of the recommendation (strong, level 1 or weak, level 2) and the quality of evidence (A, B, C, D). The recommendation state- ments are followed by a short remark, Key information (Balance of bene ts and harms, Quality of evidence, Values and preferences, Resource use and costs, Considerations for implementation), and a rationale. Each recommendation is linked to relevant SoF tables. An underlying rationale supported each practice point. Limitations of the guideline development process The evidence review prioritized RCTs as the primary source of evi- dence. For a select number of clinical questions in this guideline, the ERT undertook a comprehensive evidence review beyond RCTs. However, these reviews were not exhaustive, as specialty or regional databases were not searched, and manual searching of journals was not performed for these reviews.


However, these reviews were not exhaustive, as specialty or regional databases were not searched, and manual searching of journals was not performed for these reviews. In the development of these guidelines, no scoping exercise with patients, searches of the quali- tative literature, or formal qualitative evidence synthesis examining patient experiences and priorities were undertaken. As noted, although resource implications were considered in the formulation of recommendations, formal economic evaluations were not un- dertaken for all topics. methods for guideline development www.kidney-international.org Biographic and disclosure information Alfred K. Cheung, MD (Work Group Co-Chair), is Dialysis Research Foundation Presidential Endowed Chair, Professor of Internal Medicine, Chief of the Division of Nephrology & Hypertension, Execu- tive Director of the Dialysis Program, and Vice-chair for Research in the Department of Internal Medicine at the University of Utah, Salt Lake City, UT, USA. His research has focused on CKD, hemodialysis, vascular access, and hypertension. He has served on various com- mittees in the American Society of Nephrology, the US Na- tional Kidney Foundation, the US Food & Drug Administration, the US Centers for Medicare & Medicaid Services, and as a councilor at the International Society of Nephrology. He has also been a chartered member or ad hoc member of grant review committees for the US National Institutes of Health (NIH) and other research funding orga- nizations. He was interim Co-Editor-in-chief of the Journal of American Society of Nephrology. He co-chaired the Kidney Disease Outcome Quality Initiative (K/DOQI) guidelines on Cardiovascular Disease in Dialysis Patients. Of particular relevance to this task, he was a member of the Steering Committee and the Principal Inves- tigator of the Utah Clinical Center Network in the Systolic Blood Pressure Intervention Trial (SPRINT) sponsored by the NIH.


Of particular relevance to this task, he was a member of the Steering Committee and the Principal Inves- tigator of the Utah Clinical Center Network in the Systolic Blood Pressure Intervention Trial (SPRINT) sponsored by the NIH. Consultancy: Amgen, Bard, Boehringer Ingelheim, Calliditas, Tricida, and UpToDate Grant/research support: National Institutes of Health for SPRINT* *Monies paid to institution. Johannes F.E. Mann, MD (Work Group Co-Chair), is a professor of medicine at the University of Erlangen-N rnberg, Erlangen, Germany, and head of the KfH Kidney Centre, Munich, Germany. He is also an international scholar at the Population Health Research Institute, McMaster University, Hamilton, Can- ada. He is board-certi ed in internal medicine, nephrology, intensive care, and pharmacology. His work focused initially on the physiology of the RAS in experimental animals and later on the role of this system in the diseases of the kidney and the heart. From there, his interest moved to the treatment of progressive kidney dis- eases. The latter included steering, adjudication, and data safety monitoring board memberships in outcome trials, namely AIPRI, HOPE, MICRO-HOPE, HOPE-TOO, RENAL-ONTARGET, RENAL-TRANSCEND, ASCEND, DIABHYCAR, ORIGIN, LEADER, SONAR, SOUL, FLOW, DAPA-CKD. His scienti c work includes about 270 original papers. Consultancy: AstraZeneca, Bayer, Boehringer Ingelheim, Fresenius Medical Care, Novo Nordisk, and Vifor Fresenius Medical Care Renal Pharma Grant/research support: Boehringer Ingelheim, Canadian Institutes Health Research, European Union, Idorsia, Novo Nordisk, Sandoz, and Sano Speaker bureaus: AstraZeneca, B. Braun, Fresenius Medical Care, Novartis, Novo Nordisk, and Roche Tara I. Chang, MD, MS, is an associate professor of medicine, division chief, and director of clinical research in the Division of Nephrology at Stanford University School of Medicine in Palo Alto, CA, USA.


Consultancy: AstraZeneca, Bayer, Boehringer Ingelheim, Fresenius Medical Care, Novo Nordisk, and Vifor Fresenius Medical Care Renal Pharma Grant/research support: Boehringer Ingelheim, Canadian Institutes Health Research, European Union, Idorsia, Novo Nordisk, Sandoz, and Sano Speaker bureaus: AstraZeneca, B. Braun, Fresenius Medical Care, Novartis, Novo Nordisk, and Roche Tara I. Chang, MD, MS, is an associate professor of medicine, division chief, and director of clinical research in the Division of Nephrology at Stanford University School of Medicine in Palo Alto, CA, USA. She received her medi- cal degree at the University of Michigan before completing her internal medi- cine residency at the University of Cal- ifornia, San Francisco, CA, USA, and her nephrology fellowship at Stanford. Dr. Chang maintains an active clin- ical research program that focuses on improving cardio- vascular outcomes among patients with CKD. Dr. Chang s research projects involve clinical epidemiology and clinical trials. She recently served as a US national leader for the Canagli ozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial. Dr. Chang is a member of the KDIGO Executive Committee and is actively involved with the American Society of Nephrology and the US National Kidney Foundation. Her other re- sponsibilities include serving as an associate editor for the American Heart Journal, and as a member of the editorial boards of Kidney360, the Clinical Journal of the American Society of Nephrology, and the Journal of Human Hypertension.


Her other re- sponsibilities include serving as an associate editor for the American Heart Journal, and as a member of the editorial boards of Kidney360, the Clinical Journal of the American Society of Nephrology, and the Journal of Human Hypertension. Consultancy: Bayer, Gilead, Janssen Research and Develop- ment, Novo Nordisk, Tricida, and Vascular Dynamics Advisory boards: AstraZeneca and Fresenius Medical Care Renal Therapies Group Grant/research support: AstraZeneca and Satellite Healthcare www.kidney-international.org biographic and disclosure information William C. Cushman, MD, FAHA, FACP, is the medical director of the Department of Preventive Medicine, and a professor of preventive medicine, medicine, and physiology at the Uni- versity of Tennessee Health Science Center (UTHSC) in Memphis, TN, USA. He was trained at the University of Mississippi School of Medicine in Jack- son, Mississippi, USA. After serving on the faculty there and as staff at the Department of Veterans Affairs (VA) Medical Center, he moved to the UTHSC and the VA in Memphis, Tennessee. He retired from the VA in 2020 to assume his current position at UTHSC. Dr. Cushman is recognized for his expertise in hyperten- sion. He was a VA champion for the 2014 and 2020 US VA/ DoD Hypertension Clinical Practice Guideline committees, and was on the leadership committees for the Joint National Committee (JNC) 7 and JNC 8 US hypertension guidelines. He has participated in the leadership for many National Heart, Lung and Blood Institute, VA, and industry-sponsored clinical trials in hypertension and diabetes. He has authored more than 300 journal article and book chapter publications and has received several awards, including the 2010 VA Clinical Science Research and Development Barnwell Award, the 2017 Inter-American Society of Hypertension Lifetime Achievement Award, and the 2018 American Heart Associa- tion s Council on Hypertension Irvine Page-Alva Bradley Lifetime Achievement Award.


He has authored more than 300 journal article and book chapter publications and has received several awards, including the 2010 VA Clinical Science Research and Development Barnwell Award, the 2017 Inter-American Society of Hypertension Lifetime Achievement Award, and the 2018 American Heart Associa- tion s Council on Hypertension Irvine Page-Alva Bradley Lifetime Achievement Award. Grant/research support: National Institutes of Health* and Eli Lilly* *Monies paid to institution. Susan L. Furth, MD, PhD, is Vice- chair of the Department of Pediatrics, associate Chair for Academic Affairs, and professor of pediatrics and epide- miology at the University of Pennsyl- vania, Philadelphia, PA, USA. She is chief of the nephrology division at Children s Hospital of Philadelphia, Philadelphia, PA, USA. She is the principal investigator of the Chronic Kidney Disease in Children (CKiD) Study, the largest multicenter prospective cohort study of children with CKD ever conducted in North America, now in its 16th year. She also leads the Pediatric Center of Excellence in Nephrology at the Chil- dren s Hospital of Philadelphia. She has authored over 250 publications, and in 2020, she was awarded the Maureen Andrew Mentor Award by the Society for Pediatric Research. Grant/research support: National Institutes of Health* *Monies paid to institution. Fan Fan Hou, MD, PhD, is a nephrologist and professor of medicine at the Southern Medical University in Guangzhou, China. She is an acade- mician of the Chinese Academy of Sciences and a member of the Third World Academy of Sciences. Dr. Hou received her nephrology training at the Brigham and Women s Hospital and Harvard Medical School in Boston, MA, USA. She assumed her current position as chief of nephrology at Nanfang Hos- pital, Southern Medical University, Guangzhou, China in 1999.


She assumed her current position as chief of nephrology at Nanfang Hos- pital, Southern Medical University, Guangzhou, China in 1999. Dr. Hou has been serving as Chair of the National Clinical Research Center for Kidney Disease since 2013. She is currently a councilor of the International Society of Nephrology and an Executive Committee member of KDIGO. Dr. Hou is a clinician scientist with an interest in kidney disease, speci cally the intervention of CKD and mechanisms underlying CKD progression. She had served as a steering committee member of international clinical trials, including ALBUM, SONAR, DAPA-CKD, and principal investigator of several national trials such as ESBARI, ROAD, and CSPPT- CKD. Dr. Hou has published hundreds of papers in peer- reviewed journals such as the New England Journal of Medi- cine, the Journal of the American Medical Association, Nature Medicine, the Journal of the American Society of Nephrology, and Kidney International. Consultancy: AstraZeneca Joachim H. Ix, MD, MAS, received his medical degree from the Uni- versity of Chicago, Pritzker School of Medicine, IL, USA. He trained in internal medicine and nephrology and subsequently joined the faculty at University of California San Francisco, CA, USA. He was recruited to University of California San Diego, CA, USA, in 2007 and has served as chief of the Division of Nephrology-Hypertension at University of Cali- fornia San Diego since 2013. Dr. Ix s research interests broadly focus on the overlap between kidney disease and vascular disease. His work has primarily utilized epidemiologic methods and clinical trials to understand disease patterns that overlap between kidney and vascular disease, and to test novel therapies to improve vascular disease in the kidney patient.


His work has primarily utilized epidemiologic methods and clinical trials to understand disease patterns that overlap between kidney and vascular disease, and to test novel therapies to improve vascular disease in the kidney patient. He is particularly interested in the effects of blood pressure control on kidney disease and its complications and is a principal investigator of an NIH award focused on this topic. He also served as the San Diego Site principal investigator and a member of the CKD working group within the SPRINT trial. Dr. Ix has co-authored over 370 peer-reviewed scienti c papers, has previously served as an associate editor for the Journal of the American Society of Nephrology and Circulation. biographic and disclosure information www.kidney-international.org In 2020, he received the Shaul G. Massry Award from the US National Kidney Foundation. Consultancy: AstraZeneca and Sani t Grants/research support: Baxter International* and National Institutes of Diabetes and Digestive and Kidney Diseases* Travel expenses: American Society of Nephrology and Insti- tute of Medicine *Monies paid to institution. Gregory A. Knoll, MD, MSc, FRCPC, is head of the Division of Nephrology at the Ottawa Hospital and a professor of medicine at the University of Ottawa, Canada. He currently holds the University of Ottawa Chair in Clinical Transplantation Research and is a senior scientist with the Clinical Epidemiology Program of the Ottawa Hospital Research Institute. He completed his nephrology fellowship at the University of Ottawa, followed by a kidney transplant fellowship at the University of Alabama at Bir- mingham, USA. Following this training, he took further graduate work and received a master s degree in epidemi- ology. For over 15 years, he was the medical director of kidney transplantation at the Ottawa Hospital. He assumed his cur- rent position as head of the nephrology division in 2016.


He assumed his cur- rent position as head of the nephrology division in 2016. He is a past president of the Canadian Society of Transplantation. Dr. Knoll is involved in ongoing studies related to cardiac screening in kidney transplant candidates, systematic reviews on immunosuppressive strategies, and measuring quality in transplantation. He was the lead author on the Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation. He also served as the Co-Chair of the KDIGO Clinical Practice Guideline on Evaluation and Management of Candidates for Kidney Transplantation. Grant/research support: Canadian Institutes of Health Research* *Monies paid to institution. Paul Muntner, PhD, MHS, FASH, FAHA, is associate dean for research and a professor of epidemiology at the Uni- versity of Alabama at Birmingham (UAB), AL, USA. Additionally, he is the co-director of the UAB Pharmacoepi- demiology and Economics Research Unit. He earned a master s degree in biostatistics and a doctorate in epidemi- ology from the Johns Hopkins University, Baltimore, MD, USA. Since 2015, Dr. Muntner has served as the director for the UAB American Heart Association Strategically Focused Research Network hypertension center. He is the principal investigator on grants from the US National Heart, Lung, and Blood Institute. From 2015 to 2018, he was Vice-chair of the Statistics Committee for the American Heart Association and chaired the 2019 American Heart Association Scienti c Statement on blood pressure measurement. His research has focused on the prevention and treatment of cardiovascular disease and its risk factors. Dr. Muntner has an extensive bibliography in clinical and population hypertension, including over 500 peer-reviewed journal articles.


Dr. Muntner has an extensive bibliography in clinical and population hypertension, including over 500 peer-reviewed journal articles. Consultancy: Amgen Grant/research support: Amgen and National Institutes of Health Roberto Pecoits-Filho, MD, PhD, FASN, FACP, is a senior research sci- entist at Arbor Research Collaborative for Health in Ann Arbor, MI, USA, and a professor of medicine at the Ponti cal Catholic University of Paran in Curi- tiba, Brazil. As a clinician, he has broad activities in internal medicine and nephrology based at the university- af liated hospitals, where he was chief of the Department of Internal Medicine between 2010 and 2016, and the director of the residency program in nephrology from 2013 to 2016. Dr. Pecoits-Filho is the principal investigator for CKDOPPS, a multinational study on practice patterns and outcomes in CKD, and acts as a scien- ti c leader for clinical trials in nephrology with George Clinical, Sydney, Australia. Dr. Pecoits-Filho received his medical degree and trained in internal medicine and nephrology in Curitiba, Brazil, before completing a research nephrology fellowship at the University of Missouri, Columbia, MO, USA, and a PhD from the University of Sao Paulo, Brazil. He was a visiting scholar for extended periods at the Karolinska Institute in Sweden and the George Institute in Australia. He has participated as a principal investigator, regional leader, and on steering com- mittees in multinational clinical trials. Dr. Pecoits-Filho served as a member of the Executive Committee of the ISN (2017 2019), the SONG Initiative (2017 present), and KDIGO (2016 2018). Consultancy: Akebia, AstraZeneca, Fresenius Medical Care, and Novo Nordisk Grant/research support: Fresenius Medical Care* Speaker bureaus: AstraZeneca and Novo Nordisk *Monies paid to institution.


Consultancy: Akebia, AstraZeneca, Fresenius Medical Care, and Novo Nordisk Grant/research support: Fresenius Medical Care* Speaker bureaus: AstraZeneca and Novo Nordisk *Monies paid to institution. Mark J. Sarnak, MD, MS, is chief of the Division of Nephrology at Tufts Medical Center and the Gerald J. and Dorothy R. Friedman Professor of Medicine at Tufts University School of Medicine, Boston, MA, USA. Dr. Sarnak s primary research interest is in cardiovascular disease in CKD. He has also focused on cognitive function, novel biomarkers, and hyper- tension in CKD. Dr. Sarnak s research is funded by the NIH. www.kidney-international.org biographic and disclosure information He is a previous recipient of the Shaul Massry Award from the US National Kidney Foundation. Dr. Sarnak has a long record of national and international leadership positions in nephrology. He was Co-Chair and lead author of a review commissioned by the Kidney Council of the American Heart Association, CKD as a Risk Factor for Cardiovascular Disease. He chaired the subgroup covering CKD patients without diabetes on the previous KDIGO Blood Pressure Guideline. He chaired the Kidney Disease Outcomes Quality Initiative Commentary on the KDIGO Clinical Practice Guideline for Lipid Management in CKD, and most recently, he co-chaired the KDIGO Controversies Conference on Coronary Artery and Valvular Disease in CKD. Dr. Sarnak is a previous recipient of a K24 Midcareer Career Award in Patient-Oriented Research and has men- tored more than 20 research fellows and 9 junior faculty members. He has published more than 350 articles, including more than 85 peer-reviewed, non-review articles, with his mentee as the rst author. His mentees now include professors of medicine and chiefs of divisions of nephrology at other institutions. Consultancy: Akebia*, Bayer, and Cardurion Pharmaceuticals Grant/research support: National Institutes of Health* *Monies paid to institution.


Consultancy: Akebia*, Bayer, and Cardurion Pharmaceuticals Grant/research support: National Institutes of Health* *Monies paid to institution. Sheldon W. Tobe, MD, FRCPC, FRCP, FACP, FAHA, MScCH (HPTE), received his medical de- gree in 1985 from the University of Calgary, Alberta, Canada. Dr. Tobe trained in internal medicine and nephrology at the University of Toronto, Ottawa, Canada. He is a professor of medicine at both the University of Toronto and the Northern Ontario School of Medicine and the Nephrology Postgraduate Fellowship Di- rector at the University of Toronto. Dr. Tobe was previously the director of the nephrology division at Sunnybrook Research Institute. His clinical activities focus on hemodialysis and patients with CKD and hypertension. His main research interests are implementation science for the dissemination of cardiovascular-focused clinical practice guidelines. Dr. Tobe was Chair of the Canadian Hypertension Education Program from 2005 to 2012 and is a Co-Chair of the Canadian Car- diovascular Harmonized National Guidelines Endeavor (C- CHANGE). He also chairs the diabetes subgroup of Hyper- tension Canada s clinical practice guidelines. Dr. Tobe serves on the Board of Directors of the American Society of Hy- pertension Specialists Program. Dr. Tobe has had continuous peer-reviewed funding for 25 years. Dr. Tobe has received many teaching awards and other career distinctions, has published over 150 peer-reviewed articles, and has led and participated in peer-reviewed, investigator-initiated, and multi-centered international research collaborations. Consultancy: AstraZeneca Grant/research support: Bayer* Speaker bureaus: AstraZeneca and Janssen *Monies paid to institution. Charles R.V. Tomson, MA, BM, Bch, DM, FRCP, received his un- dergraduate training at Cambridge and Oxford, UK, and underwent clinical training in Nottingham, Newcastle upon Tyne, and Leicester, UK, before taking up consultant posts at St Barts, Lon- 2014), and Newcastle upon Tyne (2014 2018).


Tomson, MA, BM, Bch, DM, FRCP, received his un- dergraduate training at Cambridge and Oxford, UK, and underwent clinical training in Nottingham, Newcastle upon Tyne, and Leicester, UK, before taking up consultant posts at St Barts, Lon- 2014), and Newcastle upon Tyne (2014 2018). He has authored or coauthored 36 book chapters and over 250 journal articles on a wide range of topics including hypertension, CKD, and cardiovascular complications of kid- ney disease. His involvement in guideline development started with the third edition of the Renal Association Clinical Practice Guidelines. He was a member of the group that produced the KDIGO 2012 Management of Blood Pressure in CKD guide- line. He was a Health Foundation Quality Improvement Fellow at the Institute for Healthcare Improvement in Boston from 2003 to 2004, a placement that led to a keen interest in the translation of evidence into reliable practice and in shared decision-making. He was Chair of the UK Renal Registry (2006 2010), president of the Renal Association (2010 2012), and is a current trustee of Kidney Research UK. He retired from clinical practice in 2018 but returned during the COVID-19 pandemic. Travel: Attendance at a London Hatter Institute meeting organized by The Lancet and University College London with arm s length funding from pharmaceutical companies. KDIGO Chairs Michel Jadoul, MD, received his medi- cal degree in 1983 at the Universit Catholique de Louvain (UCLouvain) in Brussels, Belgium. Dr. Jadoul trained in internal medicine and nephrology under the mentorship of Professor Charles van Ypersele de Strihou. He has served as Chair at the Department of Nephrology of the Cliniques Universitaires Saint-Luc since 2003 and is currently a full clinical professor at UCLouvain.


He has served as Chair at the Department of Nephrology of the Cliniques Universitaires Saint-Luc since 2003 and is currently a full clinical professor at UCLouvain. Dr. Jadoul s clinical activities focus on the follow-up of hemodialysis and CKD patients, and his main research interests include b2-microglobulin amyloid- osis, hepatitis C, and other complications (e.g., falls, bone fractures, sudden death) in hemodialysis patients, as well as cardiovascular complications after kidney transplantation and various causes of kidney disease (e.g., drug-induced). Dr. Jadoul has coauthored over 260 scienti c papers, most of them published in major nephrology journals. He is biographic and disclosure information www.kidney-international.org currently serving as a theme editor of Nephrology Dialysis Transplantation, and he is also a country co-investigator for the Dialysis Outcomes and Practice Patterns Study (DOPPS; 2001 present). In 2008, he received the international distin- guished medal from the US National Kidney Foundation. He was previously a member of the KDIGO Executive Committee (2010 2015) and the ERA-EDTA Council (2013 2016). Presently, Dr. Jadoul is a KDIGO Co-Chair. Consultancy: Astellas*, AstraZeneca*, Merck Sharp & Dohme*, Mundipharma*, and Vifor Fresenius Medical Care Renal Pharma* Expert testimony: Vifor Fresenius Medical Care Renal Pharma* Grants / research support: Amgen*, Janssen-Cilag*, Otsuka*, and Roche* Speaker bureaus: Amgen*, Menarini*, Merck Sharp & Dohme*, Mundipharma, and Vifor Fresenius Medical Care Renal Pharma* Travel: Amgen* and Sano * *Monies paid to institution. Wolfgang C. Winkelmayer, MD, MPH, ScD, is the Gordon A. Cain Chair of Nephrology and professor of medicine at Baylor College of Medicine in Houston, TX, USA. Dr. Winkelmayer received his medical degree (1990) from the Univer- sity of Vienna, Austria, and later earned a Master of Public Health in healthcare management (1999) and a Doctor of Science in health policy (2001) from Harvard University, Cambridge, MA, USA.


Dr. Winkelmayer received his medical degree (1990) from the Univer- sity of Vienna, Austria, and later earned a Master of Public Health in healthcare management (1999) and a Doctor of Science in health policy (2001) from Harvard University, Cambridge, MA, USA. He then spent 8 years on the faculty of Brigham and Women s Hospital and Harvard Medical School, where he established himself as a proli c investigator and leader in the discipline of comparative-effectiveness research as it pertains to patients with kidney disease. From 2009 to 2014, he was the director of clinical research in the Division of Nephrology at Stanford University School of Medicine, Palo Alto, CA, USA. He assumed his current position as chief of nephrology at Baylor College of Medicine in September 2014. His main areas of research interest include comparative effectiveness and safety research of treatment strategies for anemia, as well as of various interventions for cardiovascular disease in patients with kidney disease. Dr. Winkelmayer is a member of the American Society of Clinical Investigation. His clinical passion lies in providing quality kidney care to the predominantly disadvantaged and un(der)insured population in the public safety net health system of Harris County, Texas. Dr. Winkelmayer has authored over 300 peer-reviewed pub- lications, and he has a particular interest in medical pub- lishing. He currently serves as associate editor for the Journal of the American Medical Association, was a co-editor of the American Journal of Kidney Disease from 2007 to 2016, and has been appointed to several other editorial boards of leading nephrology and epidemiology journals. He also volunteers his time toward important initiatives of the American Society of Nephrology (e.g., Public Policy Board), and he joined KDIGO volunteer leadership as an executive committee member in 2015 and has served as its Co-Chair since 2016.


, Public Policy Board), and he joined KDIGO volunteer leadership as an executive committee member in 2015 and has served as its Co-Chair since 2016. Consultancy: Akebia, Amgen, AstraZeneca, Bayer, Daiichi Sankyo, Relypsa, and Vifor Fresenius Medical Care Renal Pharma Methods Chair Marcello Tonelli, MD, SM, MSc, FRCPC, is senior associate dean (clinical research) at the Cumming School of Medicine in Calgary, Alberta, Canada. He is associate vice president (health research) at the University of Calgary. He received his medical degree from the University of Western Ontario, Canada, a Master of Science in epidemiology from Harvard University, Cambridge, MA, USA, and a Master of Science in health policy from Imperial College London, UK. He is a nephrologist and professor at the University of Calgary. Dr. Tonelli has served in the past as president of the Ca- nadian Society of Nephrology, councilor of the ISN, and a member of the KDIGO Executive Committee. Dr. Tonelli is Chair emeritus of the Canadian Task Force for Preventive Health Care, a national panel of experts that makes recom- mendations about preventive health services to Canada s 36,000 family physicians. A unique aspect of Dr. Tonelli s research program includes partnering with regional, provincial, and national decision makers to ensure that the ndings will be used to produce rational health policy. Speaker bureaus: B. Braun* *Monies donated to charity. Evidence Review Team Jonathan C. Craig, MBChB, DipCH, FRACP, M Med (Clin Epi), PhD, Evidence Review Team Director, is an interna- tionally recognized clinician and scientist and holds the position of vice president and executive dean of the College of Medicine & Public Health at Flinders Univer- sity, Adelaide, South Australia.


Evidence Review Team Jonathan C. Craig, MBChB, DipCH, FRACP, M Med (Clin Epi), PhD, Evidence Review Team Director, is an interna- tionally recognized clinician and scientist and holds the position of vice president and executive dean of the College of Medicine & Public Health at Flinders Univer- sity, Adelaide, South Australia. Professor Craig has made a signi cant contribution to the clinical research landscape in the prevention, identi cation, management, and treatment of CKD, particularly in relation to children and in indigenous communities. He has led the formation of state, national, and interna- tional networks to conduct high-quality, relevant trials in children. He has been instrumental in the development and implementation of best-practice methods and guidelines www.kidney-international.org biographic and disclosure information relating to CKD in Australia and globally. Professor Craig s many current advisory roles include member of the National Health and Medical Research Council s (NHMRC) Health Translation Advisory Committee, the Pharmaceutical Bene ts Advisory Committee, Medical Services Advisory Committee, and Commonwealth Department of Health Life Savings Drug Program. He is a past member of the World Health Organization expert review panel for global strategy and plan of action on public health, innovation and intellectual property; a past chairman of the Steering Group of the Cochrane Collaboration; and a past member of the Expert Advisory Group for the Structural Review of NHMRC s Grant Program. Dr. Craig declared no competing interests. Suetonia C. Palmer, MBChB, FRACP, PhD, Evidence Re- view Team Co-Director, is an academic nephrologist at the University of Otago at Christchurch in New Zealand. She studied medicine at the University of Otago, graduating in 1995. She became a fellow of the Royal Australasian Col- lege of Physicians in Nephrology in 2005.


She became a fellow of the Royal Australasian Col- lege of Physicians in Nephrology in 2005. She later completed a PhD in 2010 on the link between kidney function and heart health and a 2-year postdoctoral fellowship in Boston, MA, USA, at the Brigham and Women s Hospital. Dr. Palmer began as an author with the Cochrane Renal Group in 2004 during her training to become a nephrologist. Through systematic reviews, she discovered a passion for understanding more about the amount and quality of evi- dence that are required to make good clinical decisions in nephrology. She is actively engaged in the conduct of sys- tematic reviews of interventions (the treatments we use), prognosis (whether risk factors for disease link to important outcomes), and trial quality (how good is the evidence on which to base our decisions). Dr. Palmer enjoys training others in systematic review and meta-analysis using an evidence-based approach to research. She has strong collaborative links with researchers in Italy, Australia, Europe, and North America with an increasing research output, including recent publications in key internal medicine and nephrology journals. Dr. Palmer declared no competing interests. Giovanni F.M. Strippoli, MD, MPH, M Med (Clin Epi), PhD, Evidence Review Team Co-Director, has made sig- ni cant contributions to clinical research in CKD, with particular focus on prevention of kidney disease, and man- agement of kidney failure, including hemodialysis, peritoneal dialysis, and kidney transplantation. He has contributed strongly to the development of policy in the area of kidney disease management through an international network designing and conducting epidemiologic studies in the eld, including systematic reviews, RCTs, and cohort studies, among others.


He has contributed strongly to the development of policy in the area of kidney disease management through an international network designing and conducting epidemiologic studies in the eld, including systematic reviews, RCTs, and cohort studies, among others. Professor Strippoli has been an active contributor in his positions as chairman, deputy chairman, and council in nephrology societies including the ISN and the Italian Society of Nephrology, as well as editorial positions in nephrology and general medicine scienti c journals. Dr. Strippoli declared no competing interests. Martin Howell, PhD, Assistant Project Director, is a senior research fellow in health economics in the Sydney School of Public Health (University of Sydney), NSW, Australia. Since 2009, Martin has been responsible for evidence review and synthesis and the development of over 20 clinical practice guidelines for the Kidney Health Australia Caring for Australasians with Renal Impairment (KHA-CARI) guidelines group. His research focuses on applied health economics, predominantly in the areas of assessment of preferences using discrete choice methods and economic evaluations. His PhD project involved the application of a type of choice experiment known as a Best Worst Scaling survey to elicit preferences of recipients of kidney transplants for outcomes after transplantation. This methodology has since been applied to address a diverse range of health-related issues. He is currently leading the economic evaluations of 9 active clinical trials. He is an author on 57 publications ( rst author on 10). These publications show the broad application of his research from clinical trials to translation of clinical evidence to clinical practice guidelines and patient-centered care. Dr. Howell declared no competing interests.


These publications show the broad application of his research from clinical trials to translation of clinical evidence to clinical practice guidelines and patient-centered care. Dr. Howell declared no competing interests. David J. Tunnicliffe, PhD, Evidence Review Project Team Leader and Project Manager, is a research fellow at the University of Sydney, School of Public Health, and the Centre for Kid- ney Research at the Children s Hospital at Westmead, NSW, Australia. He was awarded his PhD in 2018 at the Uni- versity of Sydney. David has a research interest in meta-research and the utilization of living evidence in the management of CKD, and teaching epidemiology, which he performs through the Masters (Medicine) Clinical Epidemiology program, as a unit coordinator of introductions to systematic reviews. As part of Cochrane Kidney and Transplant, David has served as the evidence review project team leader and project manager for the 2021 update of the KDIGO 2012 Clinical Practice Guideline for the Management of Blood Pressure in CKD, providing methodological expertise on evidence syn- thesis and guideline development. His role was key in coor- dinating the formation of key clinical questions to guide literature searching and leading data extraction, critical appraisal, meta-analysis, and evidence grading. Dr. Tunnicliffe declared no competing interests. biographic and disclosure information www.kidney-international.org Fiona Russell, PhD, Cochrane Kidney and Transplant, Managing Editor, has more than 20 years experience at media organizations such as News Corp and Fairfax Media in a variety of editorial positions including reporter, sub-editor, deputy editor, and production editor. Two years as an infor- mation technology supervisor led to an ongoing technological change management role at both companies, developing new system procedures and work ows, and providing training solutions for new and existing staff.


Two years as an infor- mation technology supervisor led to an ongoing technological change management role at both companies, developing new system procedures and work ows, and providing training solutions for new and existing staff. During her editorial career, Dr. Russell also gained a bachelor s degree in journalism, international relations, and literary studies, a graduate degree in cognitive science, and a PhD in comparative cognition research. She has been the managing editor of Cochrane Kidney and Transplant since October 2015. Grants/grants pending: National Health and Medical Research Council of Australia Gail Y. Higgins, BA, Grad Ed, Grad Dip LibSc, Information Specialist, completed a bachelor s degree in arts, a graduate diploma in education from the University of Sydney, NSW, Australia, and a graduate diploma in Library Science from Kuring-gai College of Advanced Education. Following a number of years as a teacher librarian, she changed tack and spent 3 years with the NSW TAFE Information Systems Di- vision. After that, she joined the University of Sydney Library and worked as a pharmacy librarian and then as an internet training librarian. She has worked as an information specialist for the Cochrane Haematological Malignancies Group in Cologne, Germany, and the Cochrane Cancer Network in Oxford, UK. In 2007 and 2008, she completed a secondment with the World Health Organization in Geneva, Switzerland, on the International Clinical Trials Registry Platform (ICTRP) project. Ms. Higgins declared no competing interests. Tess E. Cooper, MPH, MSc (Evidence-based Health Care), Research Associate, has completed an MSc in evidence-based health care, a Master of Public Health, and a bachelor s degree in population health and marketing. Ms. Cooper is the in- house systematic reviewer for the Cochrane Kidney and Transplant Review Group, based at the University of Sydney, NSW, Australia.


Ms. Cooper is the in- house systematic reviewer for the Cochrane Kidney and Transplant Review Group, based at the University of Sydney, NSW, Australia. In addition, she works with several other Cochrane Review groups, including the Pain; Palliative and Supportive Care; Ear, Nose, and Throat (ENT); and Skin groups, based in the United Kingdom. She has research experience in evidence-based health care, long-term cohort studies, chronic disease prevention, and is a current PhD candidate researching kidney transplant patients. Grants/grants pending: Australian Government PhD scholarship Nicole Evangelidis, MPH, MPhil, Research Associate, is a public health researcher at the Centre for Kidney Research at the University of Sydney, NSW, Australia. She has experience in chronic disease prevention, patient-centered research, and the development of core outcome sets. She is interested in diet and lifestyle changes for the prevention of chronic disease. She undertook key aspects of the evidence review for the KDIGO guideline, including data extraction, synthesis, and preparation of evidence summaries. Ms. Evangelidis declared no competing interests. Brydee Cashmore, MPH, Research Associate, has a Master of Public Health from the University of Sydney, NSW, Australia, as well as a bachelor s degree in science, a double major in physiology and human nutrition, a graduate diploma in science in psychology, and a postgraduate diploma in science in human nutrition from Massey University, New Zealand. She is a researcher at the Centre for Kidney Research at the University of Sydney, where she undertakes evidence review and synthesis for Cochrane Kidney and Transplant and the KHA-CARI Guideline group. She was involved across all of the KDIGO Clinical Practice Guideline on the Manage- ment of Blood Pressure in CKD subtopics and undertook key aspects of the evidence review, including data extraction, evidence synthesis, and the writing and preparation of evi- dence summaries in MAGICapp.


She was involved across all of the KDIGO Clinical Practice Guideline on the Manage- ment of Blood Pressure in CKD subtopics and undertook key aspects of the evidence review, including data extraction, evidence synthesis, and the writing and preparation of evi- dence summaries in MAGICapp. Ms. Cashmore declared no competing interests. Rabia Khalid, MND, Research Associate, graduated from the University of Sydney, NSW, Australia, in 2016 with a Master of Nutrition and Dietetics. Since then, she has been working as an accredited practicing dietitian in the community. In 2017, she started her additional role as a researcher at the Centre for Kidney Research, where her role has ranged from helping with guideline development to assisting with and coordinating clinical trials. Her passion lies in increasing the availability of evidence-based knowledge for the general public. Ms. Khalid declared no competing interests. Claris Teng, BPsych (Hons), Research Associate, is a PhD candidate at the University of Sydney, NSW, Australia. Her thesis title is Perspectives and preferences of people with dementia and their caregivers about long-term care: estab- lishing a person-centered framework for decision-making. As a research associate, Ms. Teng undertook key aspects of the evidence review for the KDIGO Clinical Practice Guideline on the Management of Blood Pressure in CKD, including data extraction, synthesis, and preparation of ev- idence summaries. Ms. Teng declared no competing interests. www.kidney-international.org biographic and disclosure information Acknowledgments A special debt of gratitude is owed to the KDIGO Co-Chairs, Michel Jadoul and Wolfgang C. Winkelmayer, and immedi- ate past Co-Chair David C. Wheeler, for their invaluable oversight throughout the development of this guideline. In particular, we thank Jonathan Craig, Martin Howell, David Tunnicliffe, and the ERT members for their substantial contribution to the rigorous assessment of the available evi- dence.


In particular, we thank Jonathan Craig, Martin Howell, David Tunnicliffe, and the ERT members for their substantial contribution to the rigorous assessment of the available evi- dence. We acknowledge Marcello Tonelli and Lyubov Lytvyn for their guidance on strengthening the linkage between the recommendations and the evidence base and for striving to improve on the format to better meet KDIGO s aspiration for a living guideline that is consistently kept up-to-date, and above all, useful and informative to practicing clinicians. We would also like to acknowledge Debbie Maizels for her vital contributions to the artwork presented in this guideline. Lastly, we acknowledge Joseph T. Flynn for his contributions to Chapter 5: Blood pressure management in children with CKD. We are especially grateful to the Work Group members for their expertise throughout the entire process of literature review, data extraction, meeting participation, and the critical writing and editing of the statements and rationale, which made the publication of this guideline possible. The generous gift of their time and dedication is greatly appreciated. Finally, and on behalf of the Work Group, we gratefully acknowledge the careful assessment of the draft guideline by public external reviewers. The Work Group considered all of the valuable comments made, and where appropriate, suggested changes were incorporated into the nal publication.


The Work Group considered all of the valuable comments made, and where appropriate, suggested changes were incorporated into the nal publication. The following individuals and organizations provided feedback during the public review of the draft guideline: Baris Afsar, Ahmed Akl, Laith Al-Rabadi, B lent Altun, Pablo Amair, Mustafa Arici, Lynda Azzouz, George L. Bakris, Rommel Bataclan, Zineb Benjelloun, Patrick Biggar, Juliana Borborema, Victor Botero, Jordi Bover, British and Irish Hypertension Society, Lawrence Byrd, Rolando Claure-Del Granado, Indranil Dasgupta, Ian H. de Boer, Filippo De Stefano, Goffredo Del Rosso, Laura Fiersens, Joseph T. Flynn, Eleni Frangou, Daniel Froment, Alvaro Garcia, Osama Gheith, Richard J. Glassock, Claudia Fernanda Leiva Gomez, Manuel Gorostidi, Remi Goupil, William E. Haley, Tess Harris, Clarissa Havel, Lai Seong Hooi, Fan Hook Hou, Chiu- Ching Huang, R meyza Turan Kazancio glu, Said Khamis, Arif Khwaja, Bernhard Karl Kr mer, Craig B. Langman, Edgar V. Lerma, Lingyun Li, Jose Lima, Jos Ant nio Lopes, Fran- cesca Mallamaci, Partha Pratim Mandal, Roberto Ramirez Marmolejo, Michel Marre, Sandro Mazzaferro, Mehran Raghib Motlagh, Eugen Mota, Martin Myers, Narcisse Oue- draogo, Alberto Ortiz, Fabio Paglialonga, Sa_ Ime Paydas, Carmen A. Peralta, Carlos Eduardo Poli-de-Figueiredo, Harun Rashid, Maria Fernanda Slon Roblero, Nicolas Rob- erto Robles, Cibele Isaac Rodrigues, Patrick Rossignol, Luis M. Ruilope, Rafael Santamaria, Nigar Sekercioglu, Deepak Sharma, Alexander Shutov, Habib Skhiri, Andrew Smyth, Sandra J. Taler, Ekamol Tantisattamo, Nhan Tran, UK Renal Association, Markus van der Giet, Janelle Vicknair, Ji-Guang Wang, Daniel E. Weiner, Paul K. Whelton, Chi Pang Wen, Helen Yeh, Carmine Zoccali, and Muhammed Zubair. Participation in the review does not necessarily consti- tute endorsement of the content of this report by the above individuals or the organizations or institutions they represent. Alfred K. Cheung, MD Johannes F.E. Mann, MD Work Group Co-Chairs acknowledgments www.kidney-international.org References 1.


Alfred K. Cheung, MD Johannes F.E. Mann, MD Work Group Co-Chairs acknowledgments www.kidney-international.org References 1. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140:e20171904. 2. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127 e248. 3. Muntner P, Shimbo D, Carey RM, et al. Measurement of blood pressure in humans: a scienti c statement From the American Heart Association. Hypertension. 2019;73:e35 e66. 4. Turner MJ, Speechly C, Bignell N. Sphygmomanometer calibration why, how and how often? Aust Fam Physician. 2007;36:834 838. 5. Agarwal R, Pappas MK, Sinha AD. Masked uncontrolled hypertension in CKD. J Am Soc Nephrol. 2016;27:924 932. 6. Ahmad FS, Chan C, Rosenman MB, et al. Validity of cardiovascular data from electronic sources: the multi-ethnic study of atherosclerosis and HealthLNK. Circulation. 2017;136:1207 1216. 7. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;74:1376 1414. 8. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36:1953 2041. 9. Kallioinen N, Hill A, Horswill MS, et al. Sources of inaccuracy in the measurement of adult patients resting blood pressure in clinical settings: a systematic review. J Hypertens. 2017;35:421 441. 10. Drawz PE, Ix JH.


Sources of inaccuracy in the measurement of adult patients resting blood pressure in clinical settings: a systematic review. J Hypertens. 2017;35:421 441. 10. Drawz PE, Ix JH. BP Measurement in clinical practice: time to SPRINT to guideline-recommended protocols. J Am Soc Nephrol. 2018;29: 383 388. 11. ONTARGET Investigators, Yusuf S, Teo KK, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358: 1547 1559. 12. de Galan BE, Perkovic V, Ninomiya T, et al. Lowering blood pressure reduces renal events in type 2 diabetes. J Am Soc Nephrol. 2009;20: 883 892. 13. Peralta CA, McClure LA, Scherzer R, et al. Effect of intensive versus usual blood pressure control on kidney function among individuals with prior lacunar stroke: a post hoc analysis of the secondary prevention of Small Subcortical Strokes (SPS3) Randomized Trial. Circulation. 2016;133:584 591. 14. Duncombe SL, Voss C, Harris KC. Oscillometric and auscultatory blood pressure measurement methods in children: a systematic review and meta-analysis. J Hypertens. 2017;35:213 224. 15. Mingji C, Onakpoya IJ, Heneghan CJ, et al. Assessing agreement of blood pressure-measuring devices in Tibetan areas of China: a systematic review. Heart Asia. 2016;8:46 51. 16. Wan Y, Heneghan C, Stevens R, et al. Determining which automatic digital blood pressure device performs adequately: a systematic review. J Hum Hypertens. 2010;24:431 438. 17. Cohen JB, Padwal RS, Gutkin M, et al. History and justi cation of a national blood pressure measurement validated device listing. Hypertension. 2019;73:258 264. 18. Ishikawa J, Nasothimiou EG, Karpettas N, et al. Automatic of ce blood pressure measured without doctors or nurses present. Blood Press Monit. 2012;17:96 102. 19. Stergiou GS, Alpert B, Mieke S, et al.


2012;17:96 102. 19. Stergiou GS, Alpert B, Mieke S, et al. A universal standard for the validation of blood pressure measuring devices: Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ ESH/ISO) collaboration statement. Hypertension. 2018;71:368 374. 20. Roerecke M, Kaczorowski J, Myers MG. Comparing automated of ce blood pressure readings with other methods of blood pressure measurement for identifying patients with possible hypertension: a systematic review and meta-analysis. JAMA Intern Med. 2019;179:351 362. 21. Bauer F, Seibert FS, Rohn B, et al. Attended versus unattended blood pressure measurement in a real life setting. Hypertension. 2018;71:243 249. 22. Campbell NR, Conradson HE, Kang J, et al. Automated assessment of blood pressure using BpTRU compared with assessments by a trained technician and a clinic nurse. Blood Press Monit. 2005;10:257 262. 23. Lamarre-Cliche M, Cheong NN, Larochelle P. Comparative assessment of four blood pressure measurement methods in hypertensives. Can J Cardiol. 2011;27:455 460. 24. Myers MG. Automated blood pressure measurement in routine clinical practice. Blood Press Monit. 2006;11:59 62. 25. Myers MG, McInnis NH, Fodor GJ, et al. Comparison between an automated and manual sphygmomanometer in a population survey. Am J Hypertens. 2008;21:280 283. 26. Johnson KC, Whelton PK, Cushman WC, et al. Blood pressure measurement in SPRINT (Systolic Blood Pressure Intervention Trial). Hypertension. 2018;71:848 857. 27. Stergiou GS, Kollias A, Destounis A, et al. Automated blood pressure measurement in atrial brillation: a systematic review and meta- analysis. J Hypertens. 2012;30:2074 2082. 28. Chan PH, Wong CK, Pun L, et al. Diagnostic performance of an automatic blood pressure measurement device, Microlife WatchBP Home A, for atrial brillation screening in a real-world primary care setting. BMJ Open. 2017;7:e013685. 29. Cohen JB, Lotito MJ, Trivedi UK, et al.


2017;7:e013685. 29. Cohen JB, Lotito MJ, Trivedi UK, et al. Cardiovascular events and mortality in white coat hypertension: a systematic review and meta- analysis. Ann Intern Med. 2019;170:853 862. 30. Pierdomenico SD, Pierdomenico AM, Coccina F, et al. Prognostic value of masked uncontrolled hypertension. Hypertension. 2018;72:862 869. 31. Shimbo D, Muntner P. Should out-of-of ce monitoring be performed for detecting white coat hypertension? Ann Intern Med. 2019;170:890 892. 32. Ghazi L, Yaffe K, Tamura MK, et al. Association of 24-hour ambulatory blood pressure patterns with cognitive function and physical functioning in CKD. Clin J Am Soc Nephrol. 2020;15:455 464. 33. Minutolo R, Gabbai FB, Borrelli S, et al. Changing the timing of antihypertensive therapy to reduce nocturnal blood pressure in CKD: an 8-week uncontrolled trial. Am J Kidney Dis. 2007;50:908 917. 34. Mwasongwe SE, Tanner RM, Poudel B, et al. Ambulatory blood pressure phenotypes in adults taking antihypertensive medication with and without CKD. Clin J Am Soc Nephrol. 2020;15:501 510. 35. Pogue V, Rahman M, Lipkowitz M, et al. Disparate estimates of hypertension control from ambulatory and clinic blood pressure measurements in hypertensive kidney disease. Hypertension. 2009;53: 20 27. 36. Siu AL, U.S. Preventative Services Task Force. Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;163:778 786. 37. Little P, Barnett J, Barnsley L, et al. Comparison of acceptability of and preferences for different methods of measuring blood pressure in primary care. BMJ. 2002;325:258 259. 38. McGowan N, Pad eld PL. Self blood pressure monitoring: a worthy substitute for ambulatory blood pressure? J Hum Hypertens. 2010;24: 801 806. 39. Nasothimiou EG, Karpettas N, Dafni MG, et al. Patients preference for ambulatory versus home blood pressure monitoring. J Hum Hypertens. 2014;28:224 229. 40. Beyhaghi H, Viera AJ.


J Hum Hypertens. 2014;28:224 229. 40. Beyhaghi H, Viera AJ. Comparative cost-effectiveness of clinic, home, or ambulatory blood pressure measurement for hypertension diagnosis in US adults. Hypertension. 2019;73:121 131. 41. Lovibond K, Jowett S, Barton P, et al. Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study. Lancet. 2011;378:1219 1230. 42. Eguchi K, Kuruvilla S, Ishikawa J, et al. A novel and simple protocol for the validation of home blood pressure monitors in clinical practice. Blood Press Monit. 2012;17:210 213. www.kidney-international.org references 43. Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee to Review the Dietary Reference Intakes for Sodium and Potassium, Oria M, Harrison M, Stallings VA, eds. Dietary Reference Intakes for Sodium and Potassium. Available at: http://doi.org/10.17226/25353. Accessed January 15, 2021. 44. Clase CM, Carrero JJ, Ellison DH, et al. Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2020;97:42 61. 45. He J, Mills KT, Appel LJ, et al. Urinary sodium and potassium excretion and CKD progression. J Am Soc Nephrol. 2016;27:1202 1212. 46. Mills KT, Chen J, Yang W, et al. Sodium excretion and the risk of cardiovascular disease in patients with chronic kidney disease. JAMA. 2016;315:2200 2210. 47. McMahon EJ, Campbell KL, Bauer JD, et al. Altered dietary salt intake for people with chronic kidney disease. Cochrane Database Syst Rev. 2015;2: CD010070. 48. Suckling RJ, He FJ, Macgregor GA. Altered dietary salt intake for preventing and treating diabetic kidney disease. Cochrane Database Syst Rev. 2010:CD006763. 49. Hwang JH, Chin HJ, Kim S, et al. Effects of intensive low-salt diet education on albuminuria among nondiabetic patients with hypertension treated with olmesartan: a single-blinded randomized, controlled trial.


Effects of intensive low-salt diet education on albuminuria among nondiabetic patients with hypertension treated with olmesartan: a single-blinded randomized, controlled trial. Clin J Am Soc Nephrol. 2014;9:2059 2069. 50. Jardine MJ, Li N, Ninomiya T, et al. Dietary sodium reduction reduces albuminuria: a cluster randomized trial. J Ren Nutr. 2019;29:276 284. 51. Keyzer CA, van Breda GF, Vervloet MG, et al. Effects of vitamin D receptor activation and dietary sodium restriction on residual albuminuria in CKD: the ViRTUE-CKD Trial. J Am Soc Nephrol. 2017;28:1296 1305. 52. Konishi Y, Okada N, Okamura M, et al. Sodium sensitivity of blood pressure appearing before hypertension and related to histological damage in immunoglobulin a nephropathy. Hypertension. 2001;38:81 85. 53. Kwakernaak AJ, Krikken JA, Binnenmars SH, et al. Effects of sodium restriction and hydrochlorothiazide on RAAS blockade ef cacy in diabetic nephropathy: a randomised clinical trial. Lancet Diabetes Endocrinol. 2014;2:385 395. 54. McMahon EJ, Bauer JD, Hawley CM, et al. A randomized trial of dietary sodium restriction in CKD. J Am Soc Nephrol. 2013;24:2096 2103. 55. Meuleman Y, Hoekstra T, Dekker FW, et al. Sodium restriction in patients with CKD: a randomized controlled trial of self-management support. Am J Kidney Dis. 2017;69:576 586. 56. Ruilope LM, Casal MC, Guerrero L, et al. Sodium intake does not in uence the effect of verapamil in hypertensive patients with mild renal insuf ciency. Drugs. 1992;44:94 98. 57. Saran R, Padilla RL, Gillespie BW, et al. A randomized crossover trial of dietary sodium restriction in stage 3-4 CKD. Clin J Am Soc Nephrol. 2017;12:399 407. 58. Slagman MC, Waanders F, Hemmelder MH, et al. Moderate dietary sodium restriction added to angiotensin converting enzyme inhibition compared with dual blockade in lowering proteinuria and blood pressure: randomised controlled trial. BMJ. 2011;343:d4366. 59.


Moderate dietary sodium restriction added to angiotensin converting enzyme inhibition compared with dual blockade in lowering proteinuria and blood pressure: randomised controlled trial. BMJ. 2011;343:d4366. 59. Lopes de Faria JB, Friedman R, de Cosmo S, et al. Renal functional response to protein loading in type 1 (insulin-dependent) diabetic patients on normal or high salt intake. Nephron. 1997;76:411 417. 60. Luik PT, Hoogenberg K, Van Der Kleij FG, et al. Short-term moderate sodium restriction induces relative hyper ltration in normotensive normoalbuminuric Type I diabetes mellitus. Diabetologia. 2002;45:535 541. 61. Miller JA. Renal responses to sodium restriction in patients with early diabetes mellitus. J Am Soc Nephrol. 1997;8:749 755. 62. Muhlhauser I, Prange K, Sawicki PT, et al. Effects of dietary sodium on blood pressure in IDDM patients with nephropathy. Diabetologia. 1996;39:212 219. 63. Trevisan R, Bruttomesso D, Vedovato M, et al. Enhanced responsiveness of blood pressure to sodium intake and to angiotensin II is associated with insulin resistance in IDDM patients with microalbuminuria. Diabetes. 1998;47:1347 1353. 64. Dodson PM, Beevers M, Hallworth R, et al. Sodium restriction and blood pressure in hypertensive type II diabetics: randomised blind controlled and crossover studies of moderate sodium restriction and sodium supplementation. BMJ. 1989;298:227 230. 65. Houlihan CA, Allen TJ, Baxter AL, et al. A low-sodium diet potentiates the effects of losartan in type 2 diabetes. Diabetes Care. 2002;25:663 671. 66. Imanishi M, Yoshioka K, Okumura M, et al. Sodium sensitivity related to albuminuria appearing before hypertension in type 2 diabetic patients. Diabetes Care. 2001;24:111 116. 67. Petrie JR, Morris AD, Minamisawa K, et al. Dietary sodium restriction impairs insulin sensitivity in noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab. 1998;83:1552 1557. 68. Vedovato M, Lepore G, Coracina A, et al.


1998;83:1552 1557. 68. Vedovato M, Lepore G, Coracina A, et al. Effect of sodium intake on blood pressure and albuminuria in Type 2 diabetic patients: the role of insulin resistance. Diabetologia. 2004;47:300 303. 69. Yoshioka K, Imanishi M, Konishi Y, et al. Glomerular charge and size selectivity assessed by changes in salt intake in type 2 diabetic patients. Diabetes Care. 1998;21:482 486. 70. Lambers Heerspink HJ, Holtkamp FA, Parving HH, et al. Moderation of dietary sodium potentiates the renal and cardiovascular protective effects of angiotensin receptor blockers. Kidney Int. 2012;82:330 337. 71. World Health Organization. Guideline: Sodium Intake for Adults and Children. Available at: https://apps.who.int/iris/bitstream/handle/1 January 15, 2021. 72. EFSA Panel on Nutrition. Novel Foods and Food Allergens (NDA), Turck D, Castenmiller J, et al. Dietary reference values for sodium. EFSA J. 2019;17:191. 73. Dunkler D, Dehghan M, Teo KK, et al. Diet and kidney disease in high-risk individuals with type 2 diabetes mellitus. JAMA Intern Med. 2013;173: 1682 1692. 74. Smyth A, Dunkler D, Gao P, et al. The relationship between estimated sodium and potassium excretion and subsequent renal outcomes. Kidney Int. 2014;86:1205 1212. 75. Flesher M, Woo P, Chiu A, et al. Self-management and biomedical outcomes of a cooking, and exercise program for patients with chronic kidney disease. J Ren Nutr. 2011;21:188 195. 76. Greenwood SA, Koufaki P, Mercer TH, et al. Effect of exercise training on estimated GFR, vascular health, and cardiorespiratory tness in patients with CKD: a pilot randomized controlled trial. Am J Kidney Dis. 2015;65: 425 434. 77. Headley S, Germain M, Wood R, et al. Short-term aerobic exercise and vascular function in CKD stage 3: a randomized controlled trial. Am J Kidney Dis. 2014;64:222 229. 78. Howden EJ, Coombes JS, Strand H, et al. Exercise training in CKD: ef cacy, adherence, and safety.


Howden EJ, Coombes JS, Strand H, et al. Exercise training in CKD: ef cacy, adherence, and safety. Am J Kidney Dis. 2015;65:583 591. 79. Ikizler TA, Robinson-Cohen C, Ellis C, et al. Metabolic effects of diet and exercise in patients with moderate to severe CKD: a randomized clinical trial. J Am Soc Nephrol. 2018;29:250 259. 80. Leehey DJ, Collins E, Kramer HJ, et al. Structured exercise in obese diabetic patients with chronic kidney disease: a randomized controlled trial. Am J Nephrol. 2016;44:54 62. 81. Leehey DJ, Moinuddin I, Bast JP, et al. Aerobic exercise in obese diabetic patients with chronic kidney disease: a randomized and controlled pilot study. Cardiovasc Diabetol. 2009;8:62. 82. Van Craenenbroeck AH, Van Craenenbroeck EM, Van Ackeren K, et al. Effect of moderate aerobic exercise training on endothelial function and arterial stiffness in CKD stages 3-4: a randomized controlled trial. Am J Kidney Dis. 2015;66:285 296. 83. Heiwe S, Jacobson SH. Exercise training in adults with CKD: a systematic review and meta-analysis. Am J Kidney Dis. 2014;64:383 393. 84. Beddhu S, Wei G, Marcus RL, et al. Light-intensity physical activities and mortality in the United States general population and CKD subpopulation. Clin J Am Soc Nephrol. 2015;10:1145 1153. 85. Ekinci EI, Clarke S, Thomas MC, et al. Dietary salt intake and mortality in patients with type 2 diabetes. Diabetes Care. 2011;34:703 709. 86. Mente A, O Donnell M, Rangarajan S, et al. Urinary sodium excretion, blood pressure, cardiovascular disease, and mortality: a community- level prospective epidemiological cohort study. Lancet. 2018;392:496 506. 87. BiCARB study group. Clinical and cost-effectiveness of oral sodium bicarbonate therapy for older patients with chronic kidney disease and low-grade acidosis (BiCARB): a pragmatic randomised, double- blind, placebo-controlled trial. BMC Med. 2020;18:91. 88. Mahajan A, Simoni J, Sheather SJ, et al.


2020;18:91. 88. Mahajan A, Simoni J, Sheather SJ, et al. Daily oral sodium bicarbonate preserves glomerular ltration rate by slowing its decline in early hypertensive nephropathy. Kidney Int. 2010;78:303 309. references www.kidney-international.org 89. Raphael KL, Isakova T, Ix JH, et al. A randomized trial comparing the safety, adherence, and pharmacodynamics pro les of two doses of sodium bicarbonate in CKD: the BASE Pilot Trial. J Am Soc Nephrol. 2020;31:161 174. 90. Graudal NA, Hubeck-Graudal T, Jurgens G. Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Cochrane Database Syst Rev. 2017;4:CD004022. 91. Cheung AK, Rahman M, Reboussin DM, et al. Effects of intensive BP control in CKD. J Am Soc Nephrol. 2017;28:2812 2823. 92. ACCORD Study Group, Cushman WC, Evans GW, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362:1575 1585. 93. SPRINT Research Group, Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103 2116. 94. Lewington S, Clarke R, Qizilbash N, et al. Age-speci c relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360: 1903 1913. 95. Schrier RW. Blood pressure in early autosomal dominant polycystic kidney disease. N Engl J Med. 2015;372:976 977. 96. Pajewski NM, Berlowitz DR, Bress AP, et al. Intensive vs standard blood pressure control in adults 80 years or older: a secondary analysis of the Systolic Blood Pressure Intervention Trial. J Am Geriatr Soc. 2020;68:496 504. 97. Klahr S, Levey AS, Beck GJ, et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modi cation of Diet in Renal Disease Study Group.


The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modi cation of Diet in Renal Disease Study Group. N Engl J Med. 1994;330:877 884. 98. Wright JT Jr, Bakris G, Greene T, et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA. 2002;288:2421 2431. 99. Ruggenenti P, Perna A, Loriga G, et al. Blood-pressure control for renoprotection in patients with non-diabetic chronic renal disease (REIN- 2): multicentre, randomised controlled trial. Lancet. 2005;365:939 946. 100. Curb JD, Pressel SL, Cutler JA, et al. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. Systolic Hypertension in the Elderly Program Cooperative Research Group. JAMA. 1996;276:1886 1892. 101. SPS3 Study Group, Benavente OR, Coffey CS, et al. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet. 2013;382:507 515. 102. Bundy JD, Li C, Stuchlik P, et al. Systolic blood pressure reduction and risk of cardiovascular disease and mortality: a systematic review and network meta-analysis. JAMA Cardiol. 2017;2:775 781. 103. Blood Pressure Lowering Treatment Trialists Collaboration. Blood pressure-lowering treatment based on cardiovascular risk: a meta- analysis of individual patient data. Lancet. 2014;384:591 598. 104. Czernichow S, Zanchetti A, Turnbull F, et al. The effects of blood pressure reduction and of different blood pressure-lowering regimens on major cardiovascular events according to baseline blood pressure: meta- analysis of randomized trials. J Hypertens. 2011;29:4 16. 105. Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387:957 967. 106. Xie X, Atkins E, Lv J, et al.