New KDOQI commentary emphasizes early kidney testing, accurate blood pressure measurement, and individualized care
NEW YORK, Oct. 22, 2026 /PRNewswire/ — The National Kidney Foundation (NKF) is highlighting a new Kidney Disease Outcomes Quality Initiative (KDOQI) commentary on the 2025 American Heart Association/American College of Cardiology guideline for managing high blood pressure in adults. The commentary provides practical guidance for applying the recommendations to people at risk for chronic kidney disease (CKD) and those living with CKD who are not receiving dialysis. In addition, an accompanying patient editorial gives important insights from people living with hypertension.
High blood pressure can damage the kidneys, and kidney disease can make blood pressure harder to control. A highlight of the guideline is the recommendation of urine albumin-to-creatinine ratio (uACR) testing for all patients with high blood pressure. This test checks for a protein in the urine that can signal kidney damage before a decline in kidney function becomes apparent.
“Blood pressure care and kidney care go hand in hand,” said Kerry Willis, PhD, Chief Scientific Officer at NKF. “By making kidney testing a routine part of blood pressure management, clinicians can identify kidney disease earlier and make more informed treatment decisions to help protect long-term health.”
Despite its recognized importance, urine albumin testing remains underused. The commentary cites research showing that fewer than 10% of patients with high blood pressure alone receive this important testing. The authors emphasize that incorporating uACR testing into routine care can help close a critical gap in early detection and guide the selection of kidney-protective treatments.
Another significant update is the guideline’s adoption of the PREVENT cardiovascular risk calculator, which incorporates kidney function alongside other health factors to estimate the risk of heart disease and stroke. Urine albumin results can further refine that assessment, helping clinicians make treatment decisions that reflect the close connection between kidney and cardiovascular health.
“Kidney function and urine albumin results provide information that blood pressure readings alone cannot,” said Tara I. Chang, MD, of Stanford University School of Medicine and co-chair of the commentary workgroup. “This commentary helps clinicians translate that information into practical decisions about treatment, monitoring, and each patient’s health goals.”
The commentary supports a blood pressure target below 130/80, while emphasizing accurate measurement and individualized treatment. Proper cuff size, patient positioning, adequate rest, and repeated readings are essential to avoid treatment decisions based on inaccurate results. The commentary authors also discuss evidence supporting lower systolic blood pressure targets for some patients, while noting the need to consider treatment tolerance, medication side effects, and limitations in the evidence for people with advanced kidney disease.
In addition to blood pressure targets, the commentary addresses medication selection, drug interactions, and monitoring for changes in kidney function and, with some agents, potassium levels. It emphasizes collaboration among nephrologists, primary care clinicians, cardiologists, pharmacists, and other health professionals to help patients manage complex treatment plans.
“People with kidney disease often take several medications, making coordination and follow-up especially important,” said Linda Awdishu, PharmD, MAS, FASN, of the University of California San Diego and co-chair of the commentary workgroup. “A team-based approach can help patients manage their medications safely and address barriers to achieving blood pressure control.”
The KDOQI Commentary on the 2025 AHA/ACC Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults can be found here: The accompanying patient editorial can be found here.
About Kidney Disease
In the United States, CKD remains an under-recognized public health burden that impacts 1 in 7 adults, and 90 percent of those affected are unaware of their condition. Approximately 1 in 3 U.S. adults are at risk for CKD, but less than 20% are assessed with guideline-recommended testing, eGFR and uACR. Risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity, and family history. People of Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian American, or Native Hawaiian or Other Pacific Islander descent are at increased risk for developing the disease. Black or African American people are about four times as likely as White people to develop kidney failure. Hispanic and Native American people experience kidney failure at approximately double the rate of White people.
About the National Kidney Foundation
The National Kidney Foundation is revolutionizing the fight to save lives by eliminating preventable kidney disease, accelerating innovation for the dignity of the patient experience, and dismantling structural inequities in kidney care, dialysis, and transplantation. For more information about NKF, visit www.kidney.org.
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SOURCE National Kidney Foundation
