#4483 THE 2021 KDIGO BLOOD PRESSURE TARGET AND THE PROGRESSION OF CHRONIC KIDNEY DISEASE: FINDINGS FROM THE KNOW-CKD

Abstract

Abstract Background and Aims The 2021 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline for management of blood pressure (BP) in chronic kidney disease (CKD) recommends a target systolic BP of <120 mmHg because this lower target can provide cardiovascular benefits. However, whether implementing the new BP target could improve kidney outcome remains unknown. Method We examined the association of the 2021 KDIGO BP target with CKD progression compared with the 2012 KDIGO BP target among 1724 participants from the Korean Cohort Study for Outcomes in Patients With CKD. The main exposure was BP status categorized according to the 2012 or 2021 KDIGO guideline: 1) controlled within 2021 target; 2) controlled within 2012 target only; and 3) above both targets. The primary outcome was a composite kidney outcome of ≥50% decline in estimated glomerular filtration rate from baseline measurement or the initiation of kidney replacement therapy during the follow-up. Results During 8,078 person-years of follow-up (median, 4.9 years), the composite kidney outcome occurred in 650 (37.7%) participants. The incidence rates of this outcome were 55, 66.5, and 116.4 per 1,000 person-years in BP controlled within the 2021 and 2012 KDIGO targets, and BP above both targets, respectively. In the multivariable cause-specific hazard model, hazard ratios for the composite outcome were 0.76 (95% confidence interval, 0.60-0.95) for BP controlled within the 2021 target and 1.36 (95% confidence interval, 1.13-1.64) for BP above both targets, compared with BP controlled within 2012 target only. Conclusion The newly lowered BP target by the 2021 KDIGO guideline was associated with improved kidney outcome compared with BP target by the 2012 KDIGO guideline.