What Do We Know About Managing BP in Patients With CKD?
The methods of KDIGO guideline development have been described in detail elsewhere. This new KDIGO BP Guideline was developed by an international Work Group comprising individuals with a broad range of expertize including representatives of other guideline groups (Joint National Committee, International Society of Hypertension) in liaison with a member of the World Health Organization. The group included individuals with expertize in pediatrics, diabetes, and kidney transplantation. The group worked closely with an evidence review team with expertize in nephrology and in systematic review methods, meeting in person three times. Before the first meeting, the Work Group chairs commissioned the evidence report with rigorous prespecified criteria to enrich the evidence base with clinical outcome studies. Thus, to be included in the evidence review, trials need to include at least 50 patients in each arm, and these individuals needed to be followed up for at least 3 months for changes in urinary albumin excretion, or for 1 year for changes in kidney function or for clinical outcomes. The exception was trials of lifestyle modification, which needed to be of 6 weeks duration and could include BP changes as an endpoint. The draft guideline document was presented to the KDIGO Board in December 2010, and further changes were made at the request of Board members. The guideline subsequently went out for public review. A total of 198 responses were received from a total of 829 invitations, yielding a return rate of 24%, which compares favorably to the public response to the review of previous KDIGO guidelines. In addition to providing comment, respondents were asked to assess whether the recommendations were acceptable or not. None of the recommendations received an approval rating lower than 93%. Further modifications to the recommendations and accompanying text were made in response to the public review process and new data were incorporated.
How Was the Guideline Developed?
The methods of KDIGO guideline development have been described in detail elsewhere. This new KDIGO BP Guideline was developed by an international Work Group comprising individuals with a broad range of expertize including representatives of other guideline groups (Joint National Committee, International Society of Hypertension) in liaison with a member of the World Health Organization. The group included individuals with expertize in pediatrics, diabetes, and kidney transplantation. The group worked closely with an evidence review team with expertize in nephrology and in systematic review methods, meeting in person three times. Before the first meeting, the Work Group chairs commissioned the evidence report with rigorous prespecified criteria to enrich the evidence base with clinical outcome studies. Thus, to be included in the evidence review, trials need to include at least 50 patients in each arm, and these individuals needed to be followed up for at least 3 months for changes in urinary albumin excretion, or for 1 year for changes in kidney function or for clinical outcomes. The exception was trials of lifestyle modification, which needed to be of 6 weeks duration and could include BP changes as an endpoint. The draft guideline document was presented to the KDIGO Board in December 2010, and further changes were made at the request of Board members. The guideline subsequently went out for public review. A total of 198 responses were received from a total of 829 invitations, yielding a return rate of 24%, which compares favorably to the public response to the review of previous KDIGO guidelines. In addition to providing comment, respondents were asked to assess whether the recommendations were acceptable or not. None of the recommendations received an approval rating lower than 93%. Further modifications to the recommendations and accompanying text were made in response to the public review process and new data were incorporated.