Table 2.

Key guidance from the 2021 KDIGO Clinical Practice Guideline for BP Management in CKD

Chapter 1: Blood pressure measurement
Recommendation 1.1	We recommend standardized office BP measurement in preference to routine office BP measurement for the management of high BP in adults (1B).
Recommendation 1.2	We suggest that out-of-office BP measurements with ambulatory BP monitoring (ABPM) or home BP monitoring (HBPM) be used to complement standardized office BP readings for the management of high BP (2B).
Chapter 2: Lifestyle interventions for lowering blood pressure in patients with CKD not receiving dialysis
Recommendation 2.1.1	We suggest targeting a sodium intake ˂2 g of sodium per day (or ˂ 90 mmol of sodium per day, or ˂5 g of sodium chloride per day) in patients with high BP and CKD (2C).
Recommendation 2.2.1	We suggest that patients with high BP and CKD be advised to undertake moderate-intensity physical activity for a cumulative duration of at least 150 min per week, or to a level compatible with their cardiovascular and physical tolerance (2C).
Chapter 3: Blood pressure management in patients with CKD, with or without diabetes, not receiving dialysis
Recommendation 3.1.1	We suggest that adults with high BP and CKD be treated with a target systolic blood pressure (SBP) of ˂120 mm Hg, when tolerated, using standardize office BP measurement (2B).
Recommendation 3.2.1	We recommend starting (RASi) therapy (ACEi or ARB) for people with high BP, CKD, and severely increased albuminuria (G1–G4, A3) without diabetes (1B).
Recommendation 3.2.2	We suggest starting RASi (ACEi or ARB) for people with high BP, CKD, and moderately increased albuminuria (G1–G4, A2) without diabetes (2C).
Recommendation 3.2.3	We recommend starting RASi (ACEi or ARB) for people with high BP, CKD, and moderately-to-severely increased albuminuria (G1–G4, A2 and A3) with diabetes (1B).
Recommendation 3.3.1	We recommend avoiding any combination of ACEi, ARB, and direct renin inhibitor (DRI) therapy in patients with CKD, with or without diabetes (1B).
Chapter 4: Blood pressure management in kidney transplant recipients (CKD G1T–G5T)
Practice Point 4.1	Treat adult kidney transplant recipients with high BP to a target BP of ˂ 130 mm Hg systolic and ˂ 80 mm Hg diastolic using standardized office BP measurements (see Recommendation 1.1)
Recommendation 4.1	We recommend that a dihydropyridine calcium channel blocker or an ARB be used as the first-line antihypertensive agent in adult kidney transplant recipients (1C).
Chapter 5: Blood pressure management in children with CKD
Recommendation 5.1	We suggest that in children with CKD, 24-h mean arterial pressure by ABPM should be lowered to ≤50th percentile for age, sex, and height (2C).

ABPM, ambulatory BP monitoring; ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; BP, blood pressure; CKD, chronic kidney disease; RASi, renin-angiotensin system inhibitor