Association Between Nocturnal Blood Pressure Dipping and Renal Injury: A Systematic Literature Review

This systematic literature review synthesized quantitative evidence on the association between nocturnal blood pressure (BP) dipping patterns and renal injury, disease progression, and severity. PubMed was searched using structured search terms related to nocturnal BP, ambulatory blood pressure monitoring (ABPM), and renal outcomes. The search included original quantitative studies published in English between 2015 and 2026. Study eligibility was determined using the Population, Exposure, Comparator, and Outcome (PECO) framework, and the review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Methodological quality was assessed using the QualSyst appraisal tool. [AUTHOR DATA REQUIRED: Specify the exact date of the final PubMed search and clarify the study selection and quality assessment procedures, including the number of reviewers involved.] A total of 596 records were identified, of which 35 primary studies were included in the review. However, discrepancies in the intermediate PRISMA screening counts required verification against the original screening records. Across the included studies, nondipping and, particularly, reverse-dipping (riser) patterns were generally associated with albuminuria, reduced estimated glomerular filtration rate (eGFR), structural kidney injury, chronic kidney disease (CKD) progression, kidney failure, initiation of dialysis, and composite kidney outcomes. Conversely, a greater physiological decline in nocturnal BP was generally associated with more favorable renal outcomes. Nevertheless, the magnitude and independence of these associations varied according to patient population, CKD stage, outcome definitions, dipping thresholds, absolute nighttime BP, 24-hour BP burden, BP variability, and statistical adjustment methods. Overall, the findings suggested that nocturnal BP dipping patterns provided complementary prognostic information for renal risk assessment rather than serving as independent or definitive determinants of renal outcomes. The interpretation of these findings was limited by substantial clinical and methodological heterogeneity, the predominance of observational study designs, the restriction to English-language publications, and the exclusive use of PubMed as the literature database.