SYSTOLIC BLOOD PRESSURE (SBP) AND RISK OF MORTALITY IN PATIENTS ON MAINTENANCE PERITONEAL DIALYSIS (PD): A SYSTEMATIC VIEW AND META-ANALYSIS

Introduction:

A great deal of uncertainty exists regarding management of hypertension among maintenance PD patients. The International Society for Peritoneal Dialysis (ISPD) recommends targeting SBP <140 mmHg based on “very low” quality evidence. Recognizing the lack of randomized controlled trials, we conducted a systematic review of observational studies to examine the association between SBP and all-cause mortality.

Methods:

We searched PubMed, Web of Science, Embase, CINAHL and Cochrane Library databases up to April 2023 and abstracts from the 2019-2023 ASN, ISN, and NKF meetings followed by dual study screening and data extraction. We included patients on any non-acute PD types regardless of kidney failure cause. We defined SBP 100-140 mmHg as reference, pre-specified decision rules to group data for pooling, and combined data to estimate pooled risk ratios(RR) using random-effects models.

Results:

Of 3,546 peer-reviewed records, 28 full-text studies and 1 abstract were eligible (and 1conference abstract). Out of eight assessed bias domains, most studies had issues with comparability of the BP groups and the incomplete capture of prognostic factors. Based on one-time baseline measurement (i.e. not time-updated), SBP >140 (vs. 100-140) mmHg was associated with a 15% increase in risk of all-cause mortality (RR=1.15; 95%CI: 0.99-1.34) (Figure). SBP <100 (vs.100-140) mmHg was associated with even higher risk (RR=1.79; 1.38-2.32). Similar results were seen in sensitivity analyses. There was high degree of heterogeneity across all meta-analyses (I2 range: 54-88%).

Conclusions:

The existing epidemiologic literature provides limited guidance due to a high degree of heterogeneity and concerns regarding bias. But it does lend some support to the current ISPD guideline targeting SBP <140 mmHg. SBP <100 mmHg is associated with highest risk of death, but that is not a plausible consideration as a treatment target.

(Abstract previously submitted to the 2024 meeting of the American Society of Nephrology (ASN) meeting in San Diego, CA.  ASN permitted re-submitting of the abstract.)

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.