{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T12:24:01Z","timestamp":1787747041260,"version":"build-2784847793"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","funder":[{"DOI":"10.13039\/spm1nls2gjlp","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K099HL177340"],"award-info":[{"award-number":["K099HL177340"]}],"id":[{"id":"10.13039\/spm1nls2gjlp","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/sphy7xog3jjj","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K23HL167659"],"award-info":[{"award-number":["K23HL167659"]}],"id":[{"id":"10.13039\/sphy7xog3jjj","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/spu1nc5hfomr","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K23HL150290"],"award-info":[{"award-number":["K23HL150290"]}],"id":[{"id":"10.13039\/spu1nc5hfomr","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/sp9l9rzvux2a","name":"Grants to Beth Israel Deaconess Medical Center from Abbott, BD, Boston Scientific, Cook, Medtronic, and Philips","doi-asserted-by":"publisher","id":[{"id":"10.13039\/sp9l9rzvux2a","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["JASN"],"published-print":{"date-parts":[[2026,8]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n The proportion of patients with CKD whose systolic BP was within the 2021 Kidney Disease: Improving Global Outcomes (KDIGO) target increased by only 3.6% after the guideline's publication, remaining at 21.9% in 2024.<\/jats:p>\n <\/jats:list-item>\n \n The mean number of antihypertensive classes among patients with CKD increased minimally, by 0.02 (from 1.53 to 1.55), over the same period.<\/jats:p>\n <\/jats:list-item>\n \n Safety end points were generally comparable between patients with systolic BP above versus within the 2021 KDIGO target.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n The real-world uptake of the 2021 Kidney Disease: Improving Global Outcomes (KDIGO) BP guideline, which lowered the systolic BP target to <120 mm Hg for patients with CKD, is poorly understood. We examined the adoption of the 2021 KDIGO systolic BP target in clinical practice and its association with outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The study was based on data from the Mass General Brigham health care network, an integrated health care system spanning primary to tertiary care in New England. In the serial cross-sectional analysis, we identified approximately 50,000 patients with CKD stages 3\u20134 in each year from 2020 to 2024 and assessed the annual proportion of patients within the 2021 KDIGO systolic BP target. In longitudinal analysis, we identified 18,996 patients with incident CKD stages 3\u20134 in 2014\u20132019 and evaluated the association between systolic BP above versus within the target and clinical outcomes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n In the serial cross-sectional analysis, 18.3% of patients with CKD had systolic BP within the 2021 KDIGO target in 2020 (preguideline). The proportion changed only marginally after the guideline's publication: 18.0% in 2021 (absolute difference, \u22120.3% [95% confidence interval (CI), \u22121.2 to 1.3]), 19.3% in 2022 (absolute difference, 1.0% [95% CI, \u22120.1 to 2.0]), 20.0% in 2023 (absolute difference, 1.7% [95% CI, 0.2 to 3.1]), and 21.9% in 2024 (absolute difference, 3.6% [95% CI, 1.9 to 5.3]). In longitudinal analysis, patients with systolic BP above the 2021 KDIGO target exhibited higher risks of cardio-kidney end points, lower risk of hypotension, and no differences in other safety end points compared to those within the target.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Adoption of the 2021 KDIGO BP guideline remained limited in real-world practice. As of 2024, nearly four in five patients with CKD had systolic BP above the new guideline target.<\/jats:p>\n <\/jats:sec>","DOI":"10.1681\/asn.0000001046","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T17:00:31Z","timestamp":1771606831000},"page":"1764-1772","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Real-World Adoption of the 2021 KDIGO BP Guideline in CKD"],"prefix":"10.1681","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2895-6835","authenticated-orcid":false,"given":"Hyeok-Hee","family":"Lee","sequence":"first","affiliation":[{"name":"Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2460-3335","authenticated-orcid":false,"given":"So Mi Jemma","family":"Cho","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, Mass General Brigham, Boston, Massachusetts"},{"name":"Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts"},{"name":"Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5013-6112","authenticated-orcid":false,"given":"Cian P.","family":"McCarthy","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, Mass General Brigham, Boston, Massachusetts"},{"name":"Baim Institute for Clinical Research, Brookline, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9183-4507","authenticated-orcid":false,"given":"Tae-Hyun","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea"},{"name":"Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1089-3896","authenticated-orcid":false,"given":"Rishi K.","family":"Wadhera","sequence":"additional","affiliation":[{"name":"Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3861-3163","authenticated-orcid":false,"given":"Eric A.","family":"Secemsky","sequence":"additional","affiliation":[{"name":"Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8402-7435","authenticated-orcid":false,"given":"Pradeep","family":"Natarajan","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, Mass General Brigham, Boston, Massachusetts"},{"name":"Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts"},{"name":"Department of Medicine, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"issue":"3S","key":"B1-20260826","first-page":"S1","article-title":"KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease","volume":"99","year":"2021","journal-title":"Kidney Int."},{"issue":"22","key":"B2-20260826","doi-asserted-by":"crossref","first-page":"2103","DOI":"10.1056\/NEJMoa1511939","article-title":"A randomized trial of intensive versus standard blood-pressure control","volume":"373","author":"Wright","year":"2015","journal-title":"N Engl J Med."},{"issue":"9","key":"B3-20260826","doi-asserted-by":"crossref","first-page":"2812","DOI":"10.1681\/ASN.2017020148","article-title":"Effects of intensive BP control in CKD","volume":"28","author":"Cheung","year":"2017","journal-title":"J Am Soc Nephrol."},{"issue":"5","key":"B4-20260826","first-page":"337","article-title":"KDIGO clinical 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