New Guidelines Recommend Antihypertensive Therapy to Reduce Cardiovascular Disease Risk for Kidney Patients

Chicago, IL
April 29, 2004

The 20 million American adults with chronic kidney disease (CKD) should be considered in the highest risk group for developing cardiovascular disease (CVD), according to new guidelines published by the National Kidney Foundation (NKF) in the May 2004 issue of the American Journal of Kidney Diseases. The guidelines, Hypertension and Antihypertensive Agents in Chronic Kidney Disease, recommend that doctors can stabilize their kidney patients by lowering blood pressure levels to a maximum of 130/80 mm Hg.

“CKD patients with high blood pressure need to be treated differently from non-CKD patients with high blood pressure. Following our guidelines can help doctors slow the progression of kidney disease and reduce CVD risk,” explained Andrew Levey, M.D. and chair of the NKF work group that developed the guidelines. “Unlike non-CKD patients, most CKD patients will need a combination of at least two antihypertensive agents, either an angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB), and a diuretic in order to achieve target blood pressure levels.”

According to Brian J.G. Pereira, M.D., president of the National Kidney Foundation, the guidelines, developed through the NKF’s Kidney Disease Outcomes Quality Initiative (K/DOQI), provide an integrated clinical action plan. Key recommendations include:

  • Blood pressure goal of 130/80 mm Hg is appropriate for all stages of CKD
  • All patients with CKD should be considered for pharmacological therapy to slow progression of kidney disease
  • Protein in the urine, in addition to blood pressure, should be monitored to assess the response to anti-hypertensive agents
  • ACE inhibitors or ARBs are preferred agents in diabetic kidney disease and nondiabetic kidney disease with proteinuria
  • Diuretics should be used in most patients
  • Selection of additional agents to reduce CVD risk and achieve blood pressure goal should follow the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)
  • Patients with CKD are at higher risk for complications from pharmacological therapy than the general population and should be monitored more frequently
  • Lifestyle modifications to lower blood pressure and reduce CVD risk should be recommended to all CKD patients.

Guideline Work Group

The NKF-Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines: Hypertension and Antihypertensive Agents in Chronic Kidney Disease are the culmination of three years’ work reviewing evidence published in peer-reviewed medical journals by 21 volunteer experts in nephrology, cardiology, pharmacology, social work, public health, nutrition, pediatrics and internal medicine.

Chronic Kidney Disease

In 2002 the NKF published Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification that found 20 million American adults have CKD and at least 20 million more are at increased risk.

“These guidelines urge physicians to evaluate their patients with diabetes, high blood pressure or a family history of kidney disease for the presence of CKD,” said Adeera Levin, MD and K/DOQI Chair. “Three simple tests: blood pressure, serum creatinine and urinalysis, along with the estimation of the patient’s glomerular filtration rate (GFR) will help diagnose early kidney damage,” she said.

The K/DOQI Clinical Practice Guidelines address the complications and comorbidities of CKD with the goal of improving patient outcomes. Upcoming guidelines address cardiovascular disease, diabetes and updates to existing guidelines on hemodialysis, anemia, peritoneal dialysis and vascular access.

Guideline Sponsors

Sponsors of the guidelines include: Primary Development Sponsor, AstraZeneca and Implementation Sponsor, Merck & Co., Inc. Amgen is Founding and Principal Sponsor of NKF-K/DOQI.

The guidelines can be ordered by calling the National Kidney Foundation at (800) 622 – 9010 or (212) 889-2210.

About K/DOQI

The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (K/DOQI) provides evidence-based clinical practice guidelines developed by volunteer physicians and health care providers for all phases of kidney disease and related complications, from diagnosis to monitoring and management. K/DOQI expands the Dialysis Outcomes Quality Initiative or DOQI, a project begun by the National Kidney Foundation in 1995 and recognized throughout the world for improving the care of dialysis patients. For more information, please visit www.kdoqi.org.

About the National Kidney Foundation

The National Kidney Foundation is dedicated to preventing kidney and urinary tract diseases, improving the health and well being of individuals and families affected by these diseases, influencing public policy in support of the kidney community and increasing the availability of all organs for transplantation. For more information, please call 800 622-9010.