Pilot to Examine Risk and Feasibility of Remote Management of BP From CKD Through ESRD

The transition from advanced chronic kidney disease (CKD), when estimated glomerular
filtration rate (eGFR) is <30 mL/min/1.73m2, to end-stage renal disease (ESRD) represents a
vulnerable period, when multiple physiologic and psychosocial changes occur as patients
prepare for either dialysis or kidney transplant. This study is a pilot randomized controlled
trial to test the safety and feasibility of studying strict versus usual BP control in a
population of patients with advanced CKD (eGFR <30 mL/min/1.73m2), including those with
diabetes. For this pilot study, we will randomize 60 patients with advanced CKD who have
elevated BP to either a home SBP target of <120 mm Hg (intervention group) versus 130-140 mm
Hg (usual care group).

Inclusion Criteria:

Adults ≥16 years of age who meet the eGFR eligibility criteria, which will be determined
based on whether participants have

1. at least two eGFR in the last three months that are <30 mL/min/1.73m2 or

2. prior diagnosis of CKD (per electronic chart review) and at least one eGFR <30
mL/min/1.73m2

3. history of hypertension

4. mid-arm circumference between 22-37cm (BP cuff size limitation) and be able to provide
consent to participate in our study.

Exclusion criteria

Those who:

- are or are planning to become pregnant, due to inability to take multiple classes of
anti-hypertensive agents

- are marginally housed, due to concerns regarding routine follow-up

- are actively participating in a different interventional trial that may affect blood
pressure

- are unwilling to consent to participate

- institutionalized individuals or prisoners

- are actively abusing illicit drugs or alcohol

- have a history of poor or doubtful compliance (e.g., frequently missed appointments)

- have office SBP >170 mmHg

- are already taking ≥5 anti-hypertensive medications (any classes, including diuretics)
have cognitive impairment prohibiting participation in the study.