Association between blood pressure and cardiovascular events and mortality in patients on peritoneal dialysis: a systematic review and meta-analysis of observational studies

BackgroundThe association between blood pressure (BP) and adverse outcomes in peritoneal dialysis (PD) remains uncertain. This study aims to address this knowledge gap.Materials and methodsWe 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.ResultsTwenty-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.ConclusionIn 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.