Kidney Week

Abstract: PUB191

Systolic Blood Pressure (SBP) and Risk of Mortality in Patients on Maintenance Peritoneal Dialysis (PD): A Systematic Review and Meta-Analysis

Session Information

• Publication Only

Category: Dialysis

• 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

• Lee, Viangkaeo, University of California San Francisco, San Francisco, California, United States

Viangkaeo Lee

• Siami, Haleh, University of California San Francisco, San Francisco, United States

Haleh Siami, MD

• Peschard, Vanessa-Giselle, University of California San Francisco, San Francisco, California, United States

Vanessa-Giselle Peschard, MD, MA, MS, MSc

• Malekinejad, Mohsen, University of California San Francisco, San Francisco, California, United States

Mohsen Malekinejad, MD, DrPH, MPH

• Huang, Emily Xing, University of California San Francisco, San Francisco, California, United States

Emily Xing Huang

• Tahir, Peggy, University of California San Francisco, San Francisco, California, United States

Peggy Tahir, MA, MS

• Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States

Chi-yuan Hsu, MD, MS, MSc, FASN

Background

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 1 conference 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%).

Conclusion

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.

Funding

• NIDDK Support