Bezerra Rodrigo, Teles Flavio, Nadruz Wilson, Feitosa Audes D M, Coelho Jorge A P M, Ponce Daniela, Pecoits-Filho Roberto, Rodrigues Cibele I S
Keizo Asami Institute, Federal University of Pernambuco, Recife, PE, Brazil.
Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Rua dos palmares S/N - Santo Amaro, Recife, PE, Brazil.
Clin Exp Nephrol. 2025 Jun 22. doi: 10.1007/s10157-025-02719-3.
The association between blood pressure (BP) and adverse outcomes in peritoneal dialysis (PD) remains uncertain. This study aims to address this knowledge gap.
We systematically searched five databases (1964-2025) for observational studies assessing associations between BP and mortality or cardiovascular (CV) outcomes in adults on PD. Risk of bias was evaluated using the Newcastle-Ottawa Scale and ROBINS-I. Meta-analyses were performed using random- or fixed-effects models, and pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for continuous and categorical BP exposures.
Twenty-four studies comprising 28,016 patients (55% males; hypertension prevalence ranging from 39 to 95%) were included. Higher pulse pressure (PP) was consistently associated with increased all-cause (HR per 10 mmHg: 1.20; 95%CI 1.02-1.40) and CV (HR per 10 mmHg: 1.35; 95%CI 1.16-1.58) mortality. For systolic BP (SBP), no significant association was found when analyzed as a continuous variable. However, predefined thresholds revealed that all-cause mortality was significantly associated with SBP < 120 mmHg (HR: 1.55; 95%CI 1.15-2.11) and with SBP > 140 mmHg (HR: 1.18; 95%CI 1.07-1.31). Diastolic BP was not significantly associated with mortality. Additional studies linked higher BP to left ventricular hypertrophy and non-fatal CV events.
In PD patients, SBP < 120 mmHg and > 140 mmHg are associated with increased all-cause mortality, while elevated PP robustly predicts all-cause and CV mortality. These findings identify SBP and PP as key prognostic markers and potential targets in PD management.
血压（BP）与腹膜透析（PD）不良结局之间的关联仍不确定。本研究旨在填补这一知识空白。
我们系统检索了五个数据库（1964 - 2025年），以查找评估成人PD患者血压与死亡率或心血管（CV）结局之间关联的观察性研究。使用纽卡斯尔 - 渥太华量表和ROBINS - I评估偏倚风险。采用随机效应或固定效应模型进行荟萃分析，并针对连续性和分类性血压暴露计算合并风险比（HRs）及95%置信区间（CIs）。
纳入了24项研究，共28016例患者（55%为男性；高血压患病率为39%至95%）。较高的脉压（PP）始终与全因死亡率增加（每10 mmHg的HR：1.20；95%CI 1.02 - 1.40）和心血管死亡率增加（每10 mmHg的HR：1.35；95%CI 1.16 - 1.58）相关。对于收缩压（SBP），作为连续变量分析时未发现显著关联。然而，预定义阈值显示，全因死亡率与SBP < 120 mmHg（HR：1.55；95%CI 1.15 - 2.11）以及SBP > 140 mmHg（HR：1.18；95%CI 1.07 - 1.31）显著相关。舒张压与死亡率无显著关联。其他研究将较高血压与左心室肥厚和非致命性心血管事件联系起来。
在PD患者中，SBP < 120 mmHg和> 140 mmHg与全因死亡率增加相关，而升高的PP有力地预测全因死亡率和心血管死亡率。这些发现确定SBP和PP为PD管理中的关键预后标志物和潜在靶点。
