KDOQI (Kidney Disease Outcomes Quality Initiative)

NKF K/DOQI GUIDELINES

Executive Summaries | Anemia | Hemodialysis | Peritoneal Dialysis |
Vascular Access | Nutrition | CKD 2002 | Dyslipidemias | Bone Metabolism | Hypertension and Antihypertensive Agents | History of K/DOQI



  K/DOQI Clinical Practice Guidelines on Hypertension and Antihypertensive Agents in Chronic Kidney Disease

Tables

Table 1. Definition of CKD

Table 2. Stages and Prevalence of CKD

Table 3. Classification of Blood Pressure for Adults Age ≥ 18 Years (JNC 7)

Table 4. Stages of CKD and Relationship to Hypertension

Table 5. Goals for Antihypertensive Therapy in CKD

Table 6. Strategies and Therapeutic Targets for Antihypertensive Therapy in CKD

Table 7. Importance of Proteinuria in CKD

Table 8. Topics and Guidelines

Table 9. K/DOQI Principles

Table 10. Process for Evidence Review and Guideline Development

Table 11. Format for Guidelines

Table 12. Literature Search and Review by Topic

Table 13. An Example of a Summary Table

Table 14. Study Applicability

Table 15. Clinical Outcomes

Table 16. Methodological Quality

Table 17. Extrapolating Evidence from the General Population (GP) to Patients with Chronic Kidney Disease (CKD)

Table 18. Rating the Strength of the Evidence

Table 19. Rating the Strength of Guideline Recommendations

Table 20. Key Messages and Recommendations on Hypertension and Antihypertensive Agents in CKD

Table 21. Summary of Recommendations on Hypertension and Antihypertensive Agents in CKD

Table 22. Summary of Recommendations Regarding Proteinuria

Table 23. Classification and Management of Blood Pressure for Adults Age ≥ 18 Years (JNC 7)

Table 24. Risk Factors for CKD and Its Outcomes

Table 25. Definition of CKD

Table 26. Stages and Prevalence of CKD

Table 27. Classification of CKD by Diagnosis, and Prevalence Among Patients With Kidney Failure

Table 28. Definitions of Proteinuria and Albuminuria

Table 29. Importance of Proteinuria in CKD

Table 30. Stages of CKD and Relationship to Hypertension

Table 31. Prevalence of GFR Category by Albuminuria and Hypertension

Table 32. Hypothesized Pathogenetic Mechanisms of High Blood Pressure in CKD

Table 33. Possible Explanations for the Increased Risk of CVD in CKD

Table 34. Traditional vs. CKD-Related Factors Potentially Related to an Increased Risk for CVD

Table 35. Albuminuria as a Risk Factor for CVD Outcomes in Subjects With Diabetes

Table 36. Proteinuria as a Risk Factor for CVD Outcomes in Patients Without Diabetes

Table 37. Decreased GFR as a Risk Factor for CVD Outcomes

Table 38. Years Until Kidney Failure (GFR <15 mL/min/1.73 m2) Based on Level of GFR and Rate of GFR Decline

Table 39. Hemodynamic Changes in Animal Models of CKD

Table 40. Strategies and Therapeutic Targets for Antihypertensive Therapy in CKD

Table 41. Therapeutic Targets for a Hypothetical Two-Group, Parallel-Design Randomized Controlled Trial of Antihypertensive Therapy in CKD

Table 42. Recommendations to Reduce CVD Risk in CKD (Guidelines 5-7)

Table 43. Recommendations to Slow Progression of CKD (Guidelines 8-10)

Table 44. Recommendations Regarding Proteinuria (Guidelines 8-11)

Table 45. General Approach to Hypertension and Use of Antihypertensive Agents in CKD

Table 46. Guidelines and Recommendations on Hypertension and Antihypertensive Agents in CKD

Table 47. Risk Stratification and Indication for Antihypertensive Therapy and Target Blood Pressure From JNC 6, With Modification by K/DOQI Work Group

Table 48. Comparison of Guidelines for High-Risk Patients: Comparison of JNC 7, ADA, and NKF-K/DOQI Guidelines on Hypertension and Antihypertensive Agents in CKD

Table 49. Laboratory Measurements for Ascertainment of CKD

Table 50. Measurements for Ascertainment of CVD and CVD Risk Factors in CKD

Table 51. Stages of CKD: A Clinical Action Plan

Table 52. Recommended Intervals for Follow-Up Evaluation in CKD

Table 53. Recommendations for Referral to Specialists for Consultation and Co-Management of CKD

Table 54. Objectives for Evaluation of Patients With Hypertension (JNC)

Table 55. Evaluation for the Presence of CKD

Table 56. Definition of CKD

Table 57. Markers of Kidney Damage

Table 58. Equations to Estimate GFR From Serum Creatinine Concentration

Table 59. Serum Creatinine Corresponding to an Estimated GFR of 60 mL/min/1.73 m2 by the Abbreviated MDRD Study and Cockcroft-Gault Equations

Table 60. Definition of Kidney Failure (CKD Stage 5)

Table 61. Description of CKD

Table 62. Classification of CKD by Diagnosis and Prevalence Among Patients With Kidney Failure

Table 63. Clues to the Diagnosis of CKD in Adults From the Patient’s History

Table 64. Physical Examination for Evaluation of Hypertension and CKD

Table 65. Laboratory Evaluation of Patients With CKD

Table 66. Additional Clinical Interventions for Adults With GFR <60 mL/min/1.73 m2

Table 67. Risk Factors Associated With Faster GFR Decline

Table 68. Causes of Acute Decline in GFR in CKD

Table 69. Evaluation for CVD and CVD Risk Factors in CKD

Table 70. Evaluation for Comorbid Conditions

Table 71. Causes of Resistant Hypertension

Table 72. Summary of Recommendations for Evaluation of Patients With Chronic Kidney Disease

Table 73. Limitations of Casual Blood Pressure Measurements

Table 74. Proposed Thresholds for ABPM in Adults

Table 75. Circumstances for Effective Utilization of ABPM in Patients With CKD

Table 76. Special Considerations for Blood Pressure Measurement in Adults With CKD

Table 77. Clinical Clues Suggesting the Presence of Renal Artery Disease as the Cause of Hypertension and CKD

Table 78. Scoring Algorithm for Clinical Prediction Rule for Diagnosis of RAD

Table 79. Self-Management Principles

Table 80. Antihypertensive Medication Adherence Intervention Studies

Table 81. Important Components of Education

Table 82. Barriers Associated With Non Adherence to Blood Pressure Medications

Table 83. Macro Nutrient Composition and Mineral Content of the Dietary Approaches to Stop Hypertension (DASH) Diet Recommended by JNC 7, With Modification for Stages 3-4 of CKD

Table 84. Other Lifestyle Modifications Recommended by JNC 7

Table 85. Comparison of Recommended and Actual Dietary Intakes in the General Population and in Patients With CKD as Compared to Recommendations by JNC, NCEP, and ADA

Table 86. Preferred Antihypertensive Agents for CVD

Table 87. Criteria for Extrapolation of Recommendations on the Use of Antihypertensive Agents for CVD Risk Reduction from the General Population to Patients With CKD

Table 88. Review of Guidelines for CVD Risk Reduction Using Antihypertensive Agents

Table 89. Principles for Use of Antihypertensive Agents

Table 90. Recommended Intervals for Blood Pressure Monitoring Depending on Baseline SBP

Table 91. CKD and CVD Indications for Classes of Antihypertensive Agents

Table 92. Side-Effects and Contraindications of Common Antihypertensive Agents

Table 93. Dosage of Diuretics for the Treatment of Hypertension

Table 94. Dosage of Beta-Blockers for the Treatment of Hypertension

Table 95. Dosage of Agents That Inhibit the Renin-Angiotensin System for the Treatment of Hypertension

Table 96. Dosage of Calcium-Channel Blockers for the Treatment of Hypertension

Table 97. Dosage of Other Adrenergic Inhibitors for the Treatment of Hypertension

Table 98. Dosage of Direct Vasodilators for the Treatment of Hypertension

Table 99. Dosage of Aldosterone Antagonists for the Treatment of Hypertension

Table 100. Strategies to Improve Adherence to Pharmacological Therapy

Table 101. Drugs Implicated in Causing Elevations in Blood Pressure

Table 102. Combinations of Antihypertensive Agents to Be Used With Caution

Table 103. Combination Drugs for Hypertension

Table 104. Hypertension and Antihypertensive Agents in Diabetic Kidney Disease

Table 105. Stages and Clinical Features of Diabetic Kidney Disease

Table 106. Prevalence of Hypertension in Diabetic Kidney Disease

Table 107. Summary of Number of Antihypertensive Agents to Reach Target Blood Pressure

Table 108. Pharmacological Therapy: Selection of Antihypertensive Agents

Table 109. Diabetic Kidney Disease: Blood Pressure Target

Table 110. Summary of Recommendations in Diabetic Kidney Disease

Table 111. Hypertension and Antihypertensive Agents in Non-Diabetic Kidney Disease

Table 112. Stages and Clinical Features of Non-Diabetic Kidney Disease

Table 113. Prevalence of Hypertension in Non-Diabetic Kidney Disease

Table 114. Summary of Number of Antihypertensive Agents to Reach Target Blood Pressure

Table 115. Non-Diabetic Kidney Disease: Selection of Antihypertensive Agents

Table 116. Type of Kidney Disease, Level of Proteinuria, and Strength of Recommendation for ACE Inhibitors in Non-Diabetic Kidney Disease

Table 117. Non-Diabetic Kidney Disease: Blood Pressure Targets

Table 118. Summary of Recommendations in Non-Diabetic Kidney Disease

Table 119. Hypertension and Antihypertensive Agents in Kidney Disease in the Kidney Transplant Recipient

Table 120. Stages and Clinical Features of Diseases in the Kidney Transplant Recipient

Table 121. Kidney Transplant Recipients: Selection of Antihypertensive Agents

Table 122. Summary of Recommendations in Kidney Transplant Recipients

Table 123. Recommended Intervals for Monitoring Blood Pressure, GFR and Serum Potassium for Side Effects of ACE Inhibitors or ARBs in CKD

Table 124. Circumstances in Which ACE Inhibitors and ARBs Should Not Be Used

Table 125. Targets for Therapy with ACE Inhibitors and ARBs in CKD

Table 126. Adverse Effects of ACE Inhibitors and ARBs

Table 127. Dose Range for ACE Inhibitors and ARBs

Table 128. General Principles for Monitoring for Adverse Effects When Initiating ACE Inhibitors or ARBs

Table 129. Summary of Recommended Intervals to Monitor for Side Effects After Initiation or Change in Dose of ACE Inhibitor or ARB Therapy, According to Baseline Values

Table 130. Summary of Recommended Intervals to Monitor for Side Effects of ACE Inhibitor or ARB Therapy After Blood Pressure Is at Goal and Dose Is Stable, According to Baseline Values

Table 131. Adverse Events of ACE Inhibitors and ARBs in CKD

Table 132. Causes of Hypotension in Adults

Table 133. Other Medications That Can Lower Blood Pressure

Table 134. Recommendations for Detection and Management of Hypotension, According to Baseline SBP

Table 135. Causes of Acute Decline in GFR in CKD in Adults

Table 136. Recommended Intervals for Monitoring GFR According to Baseline GFR

Table 137. Changes in Management Based on Magnitude of Early Decrease in GFR

Table 138. Causes of Hyperkalemia in CKD

Table 139. Drug-Induced Hyperkalemia in CKD

Table 140. Foods With a High Potassium Content (>250 mg/100 g)

Table 141. Measures to Lower Serum Potassium Concentration

Table 142. Recommendations for Prevention and Management of Hyperkalemia, According to Baseline Serum Potassium

Table 143. Recommendations for Use of ACE Inhibitors and ARBs in Women of Child-Bearing Age

Table 144. Summary of Use of ACE Inhibitors and ARBs in CKD

Table 145. Recommended Intervals for Monitoring Blood Pressure, GFR, and Serum Potassium for Side Effects of Diuretics in CKD

Table 146. Clinical Manifestations of ECF Volume Expansion

Table 147. Classes of Diuretic Agents Used in CKD

Table 148. Adverse Effects of Diuretics

Table 149. Dose Range and Selected Pharmacokinetics for Specific Diuretic Agents in CKD

Table 150. General Principles for Monitoring for Adverse Effects When Initiating Diuretics

Table 151. Manifestations of ECF Volume Depletion

Table 152. Summary of Recommended Intervals to Monitor for Side Effects After Initiation or Change in Dose of Diuretic Therapy, According to Baseline Values

Table 153. Summary of Recommended Intervals to Monitor for Side Effects of Diuretic Therapy After Blood Pressure Is at Goal and Dose Is Stable, According to Baseline Values

Table 154. Causes of ECF Volume Depletion in CKD

Table 155. Drug-Induced Hypokalemia in CKD

Table 156. Causes of Hypokalemia in CKD

Table 157. Potassium Supplements

Table 158. Measures to Raise Serum Potassium in CKD

Table 159. Magnesium Supplements

Table 160. Use of Diuretics in CKD

Table 161. Blood Pressure Cuff Size in Children

Table 162. 90th Percentile of Blood Pressure in Girls 2 to 17 Years of Age According to Height Percentile

Table 163. 90th Percentile of Blood Pressure in Boys 2 to 17 Years of Age According to Height Percentile

Table 164. Most Common Causes of CKD in Children According to Age Group

Table 165. Topics and Guidelines

Table 166. Definitions of Some Terms Used in These Guidelines

Table 167. Ongoing Controlled Trials of Antihypertensive Agents in High-Risk Populations

Table 168. K/DOQI Principles

Table 169. Process for Evidence Review and Guideline Development

Table 170. Guidelines and Recommendations on Hypertension and Antihypertensive Agents in CKD

Table 171. Extrapolating Evidence From the General Population (GP) to Patients With Chronic Kidney Disease (CKD)

Table 172. Other Guidelines With Recommendations for CVD Risk Reduction Using Antihypertensive Agents

Table 173. Literature Search and Review by Topic

Table 174. Assessment of the Methodological Quality of a Meta-Analysis

Table 175. Assessment of the Applicability of the Conclusions of the Meta-Analysis

Table 176. Criteria for Pharmacological Therapy in CKD (Except RAD)

Table 177. An Example of a Summary Table

Table 178. Approach to Assessing Applicability

Table 179. Clinical Outcomes

Table 180. Methodological Quality

Table 181. Format for Guidelines

Table 182. Rating the Strength of Guideline Recommendations

Table 183. Rating the Strength of the Evidence

Table 184. Proposed Thresholds for Ambulatory Blood Pressure Measurements

Table 185. Studies Demonstrating that the Relationship of ABP to Hypertensive Outcomes Is Superior to CBP