NKF KDOQI GUIDELINES

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

© 2004 National Kidney Foundation, Inc.