Blood pressure variability and cerebrovascular risk in maintenance hemodialysis versus peritoneal dialysis: a comparative study

This study aimed to compare blood pressure variability (BPV) between maintenance hemodialysis (HD) and peritoneal dialysis (PD) patients and evaluate its association with cerebrovascular event risk. A prospective cohort of 374 end-stage renal disease (ESRD) patients, including 218 on HD and 156 on PD, was enrolled between January 2020 and July 2024. Clinical and laboratory data, along with 24-hour ambulatory blood pressure measurements, were collected. BPV was assessed using standard deviation (SD), coefficient of variation (CV), and average real variability (ARV). Patients were followed for 48 months to document cerebrovascular events, including stroke and transient ischemic attack (TIA). Compared to HD patients, those on PD had significantly lower 24-hour systolic blood pressure (SBP) and SBP variability (SD, ARV, and range) (all <i>p</i> < 0.01), while diastolic BPV showed no significant difference. The incidence of cerebrovascular events was higher in HD patients (14.68%) than in PD patients (7.69%) (<i>p</i> = 0.039). Elevated SBP-ARV was an independent predictor of cerebrovascular events in both groups. In HD patients, additional independent risk factors included diabetes, hypertension, HbA1c and elevated creatinine levels. Kaplan-Meier analysis demonstrated better cerebrovascular event-free survival in PD patients (<i>p</i> = 0.043). These findings suggest that HD patients experience greater BPV than PD patients, and increased BPV is independently associated with higher cerebrovascular risk. BPV monitoring and management may be beneficial in reducing cerebrovascular complications, particularly among patients undergoing HD.