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Difference in Guidelines: Controversies Prevail?

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Dr Raja Ramachandran, Chandigarh    13 January 2018

  1. The general recommendations suggest to inquire about postural dizziness and check for postural hypotension regualarly when treating CKD patients with BP-lowering drugs. We recommend achieving or maintaining a healthy weight (BMI 20-25). (1D)
  2. We recommend lowering salt intake to <90 mmol (<2 g) per day of sodium (corresponding to 5 g of sodium chloride), unless contraindicated. (1C)
  3. We recommend undertaking an exercise program compatible with cardiovascular health and tolerance, aiming for at least 30 minutes 5 times per week. (1D)
  4. To manage BP in CKD HD patients without DM, we recommend that nondiabetic adults with CKD-ND and urine albumin excretion <30 mg/24 hours (or equivalent) whose office BP is consistently >140 mmHg systolic or >90 mmHg diastolic be treated with BP-lowering drugs to maintain a BP that is consistently ≤140 mmHg systolic and ≤90 mmHg diastolic. (1B)
  5. We suggest that nondiabetic adults with CKD-ND and urine albumin excretion of 30-300 mg/24 hours (or equivalent) whose office BP is consistently >130 mmHg systolic or >80 mmHg diastolic be treated with BP-lowering drugs to maintain a BP that is consistently  ≤130 mmHg systolic and ≤80 mmHg diastolic (2D)
  6. We suggest that nondiabetic adults with CKD-ND and urine albumin excretion of >300 mg/24 hours (or equivalent) whose office BP is consistently >130 mmHg systolic or >80 mmHg diastolic be treated with BP-lowering drugs to maintain a BP that is consistently ≤130 mmHg systolic and ≤80 mmHg diastolic. (2C)
  7. We recommend that adults with diabetes and CKD-ND with urine albumin excretion <30 mg/24 hours (or equivalent) whose office BP is consistently >140 mmHg systolic or >90 mmHg diastolic be treated with BP-lowering drugs to maintain a BP that is consistently <140 mmHg systolic and <90 mmHg diastolic. (1B)
  8. We suggest that an ARB or ACEI be used in nondiabetic adults with CKD-ND and urine albumin excretion of 30-300 mg (2D) or >300 mg (1B) per 24 hours (or equivalent) in whom treatment with BP-lowering drugs is indicated. (2D)
  9. We suggest that an ARB or ACEI be used in diabetic adults with CKD-ND and urine albumin excretion of 30-300 mg (2D) or >300 mg (1B) per 24 hours (or equivalent) in whom treatment with BP-lowering drugs is indicated. (2D)

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