What is the clinical evidence from this study?

Study design: Cohort. Population: Stage 5 chronic kidney disease (CKD-G5D) on maintenance dialysis (n=426). Intervention: Hemodialysis vs. Peritoneal dialysis. Primary outcome: Composite cardiovascular event (heart failure hospitalization, acute myocardial infarction, or cardiovascular death) (HR 2.17, 95% CI 1.16-4.06, p=0.015).

What does this research mean for the field?

Hemodialysis patients exhibit significantly higher diastolic blood pressure variability than peritoneal dialysis patients, which independently predicts cardiovascular events. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To examine differences in diastolic blood pressure variability between patients receiving hemodialysis versus peritoneal dialysis and assess associations between volume overload markers and cardiovascular risk.

March 15, 2026Renal FailureOpen Access

Hemodialysis versus peritoneal dialysis and diastolic blood pressure variability: volume-dependent cardiovascular risks in maintenance dialysis patients

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Key result

Hemodialysis linked to ~2.2-fold higher risk of composite cardiovascular events versus peritoneal dialysis.

HR 2.17
95% CI 1.16-4.06
P=0.015
n=426

Why the study?

To analyze the impacts of hemodialysis versus peritoneal dialysis on diastolic blood pressure variability in Stage 5 chronic kidney disease patients and explore volume-related indicator associations.

Does hemodialysis increase the risk of composite cardiovascular events compared to peritoneal dialysis in patients with Stage 5 chronic kidney disease?

Key Points

To examine differences in diastolic blood pressure variability between patients receiving hemodialysis versus peritoneal dialysis and assess associations between volume overload markers and cardiovascular risk.
Retrospectively analyzed 426 patients with Stage 5 chronic kidney disease on maintenance dialysis (298 hemodialysis, 128 peritoneal dialysis) followed for a median of 32.5 months between January 2019 and December 2023.
Measured blood pressure variability via 24-hour ambulatory blood pressure monitoring and tracked volume indicators including interdialytic weight gain percentage, ultrafiltration volume, extracellular volume, and NT-proBNP.
Hemodialysis patients had significantly higher 24-hour diastolic blood pressure standard deviation (16.1 ± 5.3 vs 13.5 ± 4.5 mmHg, p < 0.001) and greater non-dipping prevalence (70.1% vs 53.9%, p = 0.001) than peritoneal dialysis patients.
Primary composite cardiovascular event incidence was 16.1% in hemodialysis versus 7.8% in peritoneal dialysis (adjusted HR = 2.17, 95% CI: 1.16–4.06, p = 0.015), largely driven by heart failure hospitalizations (adjusted HR = 3.24, 95% CI: 1.21–8.69, p = 0.020).
A 24-hour diastolic standard deviation ≥16 mmHg independently predicted cardiovascular events (HR = 1.15, 95% CI: 1.08–1.23, p < 0.001), with interdialytic weight gain percentage correlating strongest with variability (r = 0.45, p < 0.001).

Study Design

Type

Cohort (n=426)

Multicenter

Structured PICO

Does hemodialysis increase the risk of composite cardiovascular events compared to peritoneal dialysis in patients with Stage 5 chronic kidney disease?

Population

426 adults aged 18-80 with Stage 5 chronic kidney disease on maintenance dialysis, followed for a median of 32.5 months.

Exposure

Hemodialysis (3 sessions per week, 4 hours per session)

Comparator

Peritoneal dialysis (continuous ambulatory peritoneal dialysis or automated peritoneal dialysis)

Outcome

Composite cardiovascular event (first occurrence of heart failure hospitalization, acute myocardial infarction, or cardiovascular death) at median 32.5 months follow-uphard clinical

Main Result

Hazard Ratio: 2.17 (95% CI 1.16–4.06)

Absolute Event Rate: 16.1% vs 7.8%

p-value: p=0.015

Elevated diastolic blood pressure variability, driven by hemodialysis-associated volume fluctuations, is an independent risk factor for cardiovascular events in advanced CKD, highlighting the importance of targeted volume management.

Limitations

Retrospective design and selection bias
Single-center setting
Non-randomized subgroup analysis of volume management
Lack of longitudinal DBPV data
Unmeasured confounding factors
Single-center setting limiting generalizability
Non-randomized subgroup analysis of volume management interventions
Lack of longitudinal DBPV data during follow-up
Unmeasured confounding factors such as vascular stiffness and oxidative stress markers

Implication

HD may confer higher CV risk than PD in CKD-G5D; leaves open optimal modality choice pending RCTs.

Abstract

This retrospective study analyzed hemodialysis (HD) and peritoneal dialysis (PD) impacts on diastolic blood pressure variability (DBPV) in Stage 5 chronic kidney disease (CKD-G5D) patients, explored volume-related indicator associations with DBPV, and provided clinical volume management evidence. Patients with CKD-G5D on maintenance dialysis (January 2019-December 2023) were included (n = 426; 298 HD, 128 PD), with median follow-up of 32.5 months. DBPV was assessed via 24-hour ambulatory blood pressure monitoring (ABPM), and volume indicators included interdialytic weight gain percentage (IDWG%), ultrafiltration volume (UFV), extracellular volume/body surface area (ECV/BSA), and N-terminal pro-B-type natriuretic peptide (NT-proBNP). HD patients had significantly higher 24h DBP SD (16.1 ± 5.3 vs 13.5 ± 4.5 mmHg), 24h DBP CV (21.3 ± 5.7% vs 17.9 ± 4.9%), and non-dipping DBPV prevalence compared with PD patients (70.1% vs 53.9%, all p < 0.01). IDWG% (r = 0.45) correlated strongest with 24h DBP SD, and dialysis modality (β = 2.31) and IDWG% (β = 1.95) were main DBPV influencers (both p < 0.001). 24h DBP SD ≥16 mmHg (dichotomous variable, HR = 1.15, 95% CI:1.08-1.23, p < 0.001) and HD modality independently predicted cardiovascular events. Targeted volume management improved DBPV in HD patients with IDWG% >5%. These results suggest that monitoring DBPV and IDWG% should be incorporated into routine dialysis care to mitigate cardiovascular risk.

Discussion

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Published by Renal Failure · CC BY

Cite This Study

Wu et al. (2026) conducted a cohort in Stage 5 chronic kidney disease (CKD-G5D) on maintenance dialysis (n=426). Hemodialysis vs. Peritoneal dialysis was evaluated on Composite cardiovascular event (heart failure hospitalization, acute myocardial infarction, or cardiovascular death) (HR 2.17, 95% CI 1.16-4.06, p=0.015). Hemodialysis was independently associated with a higher risk of composite cardiovascular events compared to peritoneal dialysis (adjusted HR 2.17, p=0.015).

synapsesocial.com/papers/69b64c9ab42794e3e660dd45 https://doi.org/10.1080/0886022x.2026.2641980

Topics

Women and heart disease

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Implication

HD may confer higher CV risk than PD in CKD-G5D; leaves open optimal modality choice pending RCTs.

Hemodialysis versus peritoneal dialysis and diastolic blood pressure variability: volume-dependent cardiovascular risks in maintenance dialysis patients

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Topics

Hemodialysis versus peritoneal dialysis and diastolic blood pressure variability: volume-dependent cardiovascular risks in maintenance dialysis patients

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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