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

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 (<i>n</i> = 426; 298 HD, 128 PD), with median follow-up of 32.5 months. DBPV was assessed <i>via</i> 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 <i>p</i> < 0.01). IDWG% (<i>r</i> = 0.45) correlated strongest with 24h DBP SD, and dialysis modality (β = 2.31) and IDWG% (β = 1.95) were main DBPV influencers (both <i>p</i> < 0.001). 24h DBP SD ≥16 mmHg (dichotomous variable, HR = 1.15, 95% CI:1.08-1.23, <i>p</i> < 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.