Commentary on the KDIGO Clinical Practice Guideline for the management of blood pressure in chronic kidney disease.

Elevated blood pressure is an important modifiable risk factor for both cardiovascular disease (CVD) and progression to end-stage kidney disease (ESKD). Much time and effort in chronic kidney disease (CKD) clinics is spent on measuring blood pressure, deciding whether to escalate treatment, and which agent to use. Blood pressure is therefore an essential topic for the Kidney Disease Improving Global Outcomes (KDIGO) group to tackle. Their Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease, published in Kidney International in December 2012, makes 21 recommendation statements based on the available evidence presented by the Tufts Medical Centre-based Evidence Review Team (summarized in 62 supplemental tables). The KDIGO Blood Pressure Guideline illustrates some of the challenges of writing evidence-based guidelines, which are: (i) distilling a complicated clinical issue into a practical guideline statement that can be implemented; (ii) adjudicating the quality of evidence for each statement; and (iii) remaining consistent within the guideline and with guidelines for other topics.