Abstract:
This practice guideline was developed by the chronic kidney disease (CKD) Task Force, which was composed of clinical and methodological experts. The Saudi Arabian Ministry of Health and its health holding company commissioned this guideline project to support the realization of Vision 2030\'s health-care transformation pillar. The synthesis of these guidelines was guided by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)- ADOLOPMENT methodology. The final guidelines addressed 12 clinical questions on the management of blood pressure in patients with CKD through a set of recommen-dations and performance measures. The recom-mendations included antihypertensive agents in children; renin- angiotensin system inhibition (RASi) versus non-RASi in adults; intensive versus standard blood pressure targets; early versus late assessment for kidney replacement therapy (KRT); late versus early preparation strategies for KRT; CKD symptoms during assessment for KRT or conservative manage-ment; initiation of KRT in patients with deteriorating CKD; choice of KRT modality or conservative management in certain CKD patient groups; changing or discontinuing KRT modalities; the frequency of reviews for KRT or conservative management; and information, education, and support. These conditional recommendations were based on a low to very low certainty of evidence, which highlights the need for high-quality randomized trials com-paring different antihypertensive agents in patients with CKD.
摘要:
本实践指南由慢性肾脏病(CKD)工作组制定,由临床和方法学专家组成。沙特阿拉伯卫生部及其健康控股公司委托该指南项目,以支持实现2030年愿景的医疗保健转型支柱。这些准则的综合以建议评估的分级为指导,发展,和评估(等级)-青少年方法论。最终指南通过一系列建议和绩效指标解决了CKD患者血压管理的12个临床问题。建议包括儿童降压药;成人肾素-血管紧张素系统抑制(RASi)与非RASi比较;强化血压目标与标准血压目标;肾脏替代疗法(KRT)的早期评估与晚期评估;KRT的晚期与早期准备策略;KRT评估或保守管理期间的CKD症状;CKD恶化患者开始KRT治疗;某些CKD患者组的KRT模式的选择或保守管理;教育,和支持。这些有条件的建议是基于低至非常低的证据确定性,这凸显了在CKD患者中需要比较不同抗高血压药的高质量随机试验。