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What Do We Know About Managing BP in Patients With CKD?

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What Do We Know About Managing BP in Patients With CKD?

Why Are There No Recommendations for Blood Pressure Management in CKD Patients Receiving Hemodialysis?


The KDIGO policy has been to ensure that sufficient evidence is available before embarking on the development of a particular Clinical Practice Guideline. Lack of evidence inevitably leads to 'opinion-based' suggestions that reflect the consensus view of the Work Group. It could be argued that providing healthcare professionals with some guidance based on the views of 'experts' is helpful and better than providing no guidance at all. However, expert opinion without sufficient supporting evidence may be subsequently proven to be wrong, and development of such 'opinion-based' guidance can impair the development of clinical trials designed to properly address the relevant question.

Before the development of the BP Guideline, KDIGO organized a consensus conference on the topic of BP management in CKD 5 patients receiving dialysis, held in New York in March 2009. The conference report concluded that there was uncertainty about how to measure BP in hemodialysis patients, a poor understanding of the association between BP and risk of adverse outcomes, and a complex interplay of factors influencing both systolic and diastolic pressure. As a result, the KDIGO executive decided that it was premature to make recommendations regarding BP management in CKD Stage 5D patients.

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