What is the target blood pressure for adults with chronic kidney disease?

There is no single universally agreed target: KDIGO's most recent guidance favors an intensive SBP target below 120 mmHg using standardized office measurement, while many other guidelines (Korean, UK, Brazilian, older KDIGO-based summaries) set a target of <140/90 mmHg for CKD without significant albuminuria/proteinuria and <130/80 mmHg for CKD with albuminuria or diabetic kidney disease with proteinuria; older adults and those with ADPKD have guideline-specific adjustments (e.g., 150/80-150/90 mmHg in the very elderly, <130 mmHg SBP per Hypertension Canada for ADPKD).

Guideline recommendations by proteinuria/albuminuria status

• For CKD patients with hypertension, the Korean Society of Hypertension (2018) recommends a target BP of 140/90 mmHg, with a target BP <130/80 mmHg considered for those with albuminuria.
• The 2013 Korean Society of Hypertension guideline similarly recommended a target SBP of less than 140 mmHg regardless of diabetes status, with a target SBP below 130 mmHg recommended for those with prominent albuminuria.
• KDIGO guidelines recommend a target office BP in adults without albuminuria of consistently <140/90 mmHg, and in adults with any level of albuminuria of consistently <130/80 mmHg, irrespective of diabetes.
• For diabetic kidney disease with CKD stages 4-5, the UK Association of British Clinical Diabetologists/Renal Association 2021 guideline proposes a target BP of <140/90 mmHg for those without significant proteinuria and <130/80 mmHg for those with significant proteinuria (UACR >3 mg/mmol).
• For older adults with CKD, the same UK guideline update notes little evidence base for specific targets, citing HYVET-derived inference of a target of 150/80 mmHg in people with CKD and eGFR >40 mL/min/1.73 m2, and STOP Hypertension supporting a target no lower than 150/90 mmHg in older patients with diabetes.
• The 7th Brazilian Guideline of Arterial Hypertension (2016) sets targets of <140/90 mmHg for non-diabetic CKD with albuminuria <30 mg/24h and <130/80 mmHg for non-diabetic CKD with albuminuria >30 mg/24h; diabetic CKD is targeted at <130/80 mmHg regardless of albuminuria level.
• A comparative table of major guidelines shows a wide range of targets for non-dialysis CKD with or without proteinuria: JNC8-2014 <140/<90, ACC/AHA-2018/2025 <130/<80 or SBP<130, ESC/ESH-2018 SBP 130-140, ISH-2020 <130/<80 (or <140/90 in elderly), WHO-2021 SBP<130, ESH-2023 SBP 130-140, KDIGO-2021/2024 SBP<120, ESC-2024 SBP 120-129/DBP 70-79, and Brazilian Hypertension Guidelines-2025 <130/80.
• KDIGO 2021 guidance is cited elsewhere as recommending an SBP target below 120 mmHg in adults with CKD.
• For autosomal dominant polycystic kidney disease specifically, KDIGO recommends targeting SBP <120 mmHg in patients over age 50 using standardized office BP measurement (Recommendation 2.1.4, level 2C, low certainty of evidence), while Hypertension Canada (2025) recommends an SBP target of <130 mmHg.

Trial evidence and historical evolution of targets

• In the SPRINT trial, the intensive systolic BP goal of <120 mmHg was associated with a 25% lower cardiovascular disease risk and 27% lower all-cause mortality compared with the standard goal of systolic BP <140 mmHg, before the trial was stopped early in September 2015; this led the 2017 AHA/ACC guideline to recommend a BP goal of <130/80 mmHg in CKD patients and those with increased cardiovascular risk, partly due to concerns about non-standardized clinic BP measurement and more hypotensive/acute kidney injury events in the intensive group; the 2018 ESH/ESC guidelines subsequently recommended a goal of SBP between 130 and 139 mmHg in CKD hypertension.
• In a cohort study of pre-dialysis CKD patients, those with blood pressure below the K/DOQI, JNC 7, and AHA target of <130/80 mmHg had the slowest decline in renal function and latest start of renal replacement therapy.

Sources

• 2018 Korean Society of Hypertension Guidelines for the management of hypertension: part II-diagnosis and treatment of hypertension — Clinical Hypertension
• Management of hypertension and renin-angiotensin-aldosterone system blockade in adults with diabetic kidney disease: Association of British Clinical Diabetologists and the Renal Association UK guideline update 2021 — BMC Nephrology
• Canadian Society of Nephrology Commentary on the 2025 Kidney Disease Improving Global Outcomes Clinical Practice Guidelines for Autosomal Dominant Polycystic Kidney Disease — Canadian Journal of Kidney Health and Disease
• 2013 Korean Society of Hypertension guidelines for the management of hypertension. Part II—treatments of hypertension — Clinical Hypertension
• Carotid Atherosclerosis in Chronic Kidney Disease: Pathophysiological Mechanisms, Prevention and Tailored Clinical Management — Journal of Clinical Medicine
• Hypertension Management in Patients with Chronic Kidney Disease — Methodist DeBakey Cardiovascular Journal
• Battle of the giants: KDIGO vs. Cochrane — who is the winner in the fight for blood pressure targets in chronic kidney disease? — Jornal Brasileiro de Nefrologia
• Blood pressure management in hypertensive people with non-dialysis chronic kidney disease in Queensland, Australia — BMC Nephrology
• Association of blood pressure with decline in renal function and time until the start of renal replacement therapy in pre-dialysis patients: a cohort study — BMC Nephrology
• 7th Brazilian Guideline of Arterial Hypertension: Chapter 8 - Hypertension and Associated Clinical Conditions — Arquivos Brasileiros de Cardiologia
• Association of blood pressure and long‐term change with chronic kidney disease risk among Chinese adults with different glucose metabolism according to the 2017 ACC/AHA guidelines — The Journal of Clinical Hypertension

Decision support for clinicians, not medical advice. Answers are grounded in the published literature and every claim cites its source in the interactive view.