Blood Pressure Dipping Status in Chronic Kidney Disease and Association With Adverse Outcomes: A Systematic Review and Meta‐Analysis

Background Nondipping, <10% nighttime blood pressure reduction, is common in chronic kidney disease (CKD). We conducted a systematic review to determine CKD nondipper prevalence, nondipper risk between patients with and without CKD and adverse events associated with nondippers in CKD. Methods CKD population studies undergoing an automated blood pressure monitor were searched for on MEDLINE, Embase, and CENTRAL (December 2023), included if they had nondipper information and excluded if they examined only a specific population. Random‐effects analysis was conducted to determine prevalence and relative risk (RR) with 95% CI. Risk of bias was assessed with the Joanna Briggs Institute score for prevalence studies and Newcastle‐Ottawa Scale for observational studies. A sensitivity analysis excluded studied with a high risk of bias. Heterogeneity was examined using I 2 and SD. Results We included 63 articles with 54 515 patients; 33 825 with CKD and 20 690 without CKD. CKD nondipper prevalence was 0.53 (95% CI, 0.52–0.53, SD=13.5%). Compared with patients with CKD, those without CKD had a lower risk of nondipping status (RR, 0.69 [95% CI, 0.63–0.75], SD=14.1%, P <0.001). Similar findings were seen in the sensitivity analysis. CKD, dippers compared with nondippers, was associated with a lower mortality (RR, 0.60 [95% CI, 0.49–0.72], SD=3.2%, P <0.001), cardiovascular events (RR, 0.63 [95% CI, 0.47–0.85], SD=28.3%, P <0.001), and CKD progression (RR, 0.64 [95% CI 0.55–0.75], SD=14.1%, P <0.001). Conclusions Nondipping is prevalent in CKD, with CKD itself a risk factor. Nondipping was associated with mortality, cardiovascular event, and CKD progression. Almost all included studies were retrospective cohorts, with a high heterogeneity found.