Nighttime Systolic Blood Pressure and Cardiovascular and All-Cause Mortality in Peritoneal Dialysis Patients: A Single-Center Prospective Cohort Study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: End-stage renal disease on peritoneal dialysis (n=165). Intervention: Elevated nighttime systolic blood pressure vs. Lower nighttime systolic blood pressure. Primary outcome: Cardiovascular mortality (SHR 1.53, 95% CI 1.05-2.21, p=0.026).

Q: What does this research mean for the field?

Each 1 SD increase in nighttime systolic blood pressure is independently associated with a 53% increased risk of cardiovascular mortality in patients receiving peritoneal dialysis. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jing Yu; Jianwen Yu; Rui Yang; Yagui Qiu; Jianbo Li; Xiao Yang; Wei Chen; Xi Xia; Qinghua Liu

doi:10.3390/jcm15187300

September 19, 2026Journal of Clinical MedicineOpen Access

Nighttime Systolic Blood Pressure and Cardiovascular and All-Cause Mortality in Peritoneal Dialysis Patients: A Single-Center Prospective Cohort Study

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Key result

Higher nighttime SBP is linked to ~53% higher CV mortality per SD in peritoneal dialysis.

SHR 1.53
95% CI 1.05-2.21
P=0.026
n=165

Figures

Why the study?

The association between ambulatory blood pressure measurements, specifically nighttime systolic blood pressure, and survival outcomes in peritoneal dialysis patients remains uncertain.

Does elevated nighttime systolic blood pressure increase the risk of cardiovascular and all-cause mortality in patients receiving peritoneal dialysis?

Key Points

To examine whether nighttime systolic blood pressure obtained from 24-hour ambulatory blood pressure monitoring is associated with cardiovascular and all-cause mortality in peritoneal dialysis patients.
Conducted a single-center prospective sub-cohort study of 165 peritoneal dialysis patients enrolled between 1 January 2017 and 30 June 2021, with a median follow-up of 47.4 months after 24-hour ambulatory blood pressure monitoring.
Used Fine-Gray competing risk regression to evaluate cardiovascular mortality and multivariable Cox proportional hazards regression to evaluate all-cause mortality across nighttime systolic blood pressure levels and quartiles.
Over median follow-up, 48 patients (29.1%) died, with 28 deaths (58.3%) attributed to cardiovascular causes.
In fully adjusted competing risk regression, each 1 SD rise in nighttime systolic blood pressure was associated with increased cardiovascular mortality (SHR: 1.53, 95% CI, 1.05–2.21; p = 0.026), with quartile 4 conferring an SHR of 3.81 (95% CI, 1.16–12.57; p = 0.028) versus quartile 1.
In multivariable Cox regression, each 1 SD increase in nighttime systolic blood pressure was associated with a 42% higher risk of all-cause mortality (HR: 1.42, 95% CI, 1.04–1.93; p = 0.026), with quartile 4 conferring an HR of 4.16 (95% CI, 1.33–12.95; p = 0.014) versus quartile 1.

Study Design

Type

Cohort (n=165)

Multicenter

No

Structured PICO

Does elevated nighttime systolic blood pressure increase the risk of cardiovascular and all-cause mortality in patients receiving peritoneal dialysis?

P

Population

165 adults on peritoneal dialysis, free of active malignancy or recent hemodialysis, followed for a median of 47.4 months to evaluate the prognostic value of ambulatory blood pressure.

E

Exposure

Elevated nighttime systolic blood pressure (SBP) obtained from 24-h ambulatory blood pressure monitoring (ABPM)

C

Comparator

Lower nighttime systolic blood pressure (lowest quartile ≤125 mmHg)

O

Outcome

Cardiovascular mortality (evaluated using competing risk regression)hard clinical

Main Result

Hazard Ratio: 1.53 (95% CI 1.05–2.21)

p-value: p=0.026

Elevated nighttime systolic blood pressure, frequently missed by office measurements, is a significant and independent predictor of cardiovascular and all-cause mortality in peritoneal dialysis patients.

Limitations

Single-center prospective observational study with a relatively modest sample size
ABPM was performed only at baseline, without longitudinal follow-up data on BP trajectories
No adjustment for volume status or the dosage and timing of antihypertensive medications
Voluntary nature of ABPM participation (33% participation rate) may introduce selection bias
Relatively low comorbidity burden warrants caution when extrapolating to older, more comorbid PD populations
Small sample size
Single-center design
ABPM performed only at baseline
No adjustment for volume status or antihypertensive dosing
Selection bias due to voluntary ABPM participation

Implication

Nighttime SBP may aid risk stratification in peritoneal dialysis; hypothesis-generating for interventional trials.

Abstract

Background/Objectives: The link between ambulatory-blood-pressure-derived measurements and survival outcomes among patients receiving peritoneal dialysis (PD) remains uncertain. This study sought to explore whether nighttime systolic blood pressure (SBP) obtained from 24-h ambulatory blood pressure monitoring (ABPM) is associated with cardiovascular (CV) and all-cause mortality in PD individuals. Methods: Between 1 January 2017 and 30 June 2021, this single-center sub-cohort study (derived from a prospective database of PD) enrolled 165 PD participants with a median follow-up of 47.4 months from the date of ABPM completion. Competing risk regression was applied to estimate the association between nighttime SBP and CV mortality, accounting for competing death events. Multivariable Cox proportional hazards regression was utilized to quantify nighttime SBP’s independent correlation with all-cause mortality. Results: Over the follow-up period, 48 patients (29.1%) died, with 28 (58.3%) cases attributed to CV causes. In the fully adjusted model, each 1 SD rise in nighttime SBP corresponded to a subdistribution hazard ratio (SHR) of 1.53 (95% confidence interval [CI], 1.05–2.21; p = 0.026) for CV mortality. In the Cox regression model, every 1 SD increase in nighttime SBP showed an independent association with a 42% excess risk of all-cause mortality (hazard ratio [HR] = 1.42, 95% CI, 1.04–1.93; p = 0.026). Quartile-stratified analyses indicated that participants within the uppermost nighttime SBP quartile exhibited higher mortality risk for both endpoints compared to those in the lowest quartile. Conclusions: Elevated nighttime SBP is associated with increased CV and all-cause mortality risk in PD patients.

Discussion

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Cite This Study

Yu et al. (2026) conducted a cohort in End-stage renal disease on peritoneal dialysis (n=165). Elevated nighttime systolic blood pressure vs. Lower nighttime systolic blood pressure was evaluated on Cardiovascular mortality (SHR 1.53, 95% CI 1.05-2.21, p=0.026). Each 1 SD increase in nighttime systolic blood pressure was associated with a 53% increased risk of cardiovascular mortality (SHR 1.53, 95% CI 1.05-2.21, p=0.026) in patients receiving peritoneal dialysis.

synapsesocial.com/papers/6ad0fd553afa093ea9ad03a4 https://doi.org/10.3390/jcm15187300

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Nighttime Systolic Blood Pressure and Cardiovascular and All-Cause Mortality in Peritoneal Dialysis Patients: A Single-Center Prospective Cohort Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Nighttime Systolic Blood Pressure and Cardiovascular and All-Cause Mortality in Peritoneal Dialysis Patients: A Single-Center Prospective Cohort Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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