Blood pressure variability is increasingly recognized as an indicator of cardiovascular risk in dialysis populations, yet the influence of dialysis modality remains uncertain. A retrospective analysis published in Renal Failure assessed whether dialysis type was associated with differences in diastolic blood pressure variability (DBPV) among patients with Stage 5 chronic kidney disease requiring dialysis (CKD-G5D).

DBPV was assessed using 24-hour ambulatory blood pressure monitoring (ABPM). Volume-related indicators included interdialytic weight gain percentage (IDWG%), extracellular volume/body surface area (ECV/BSA), ultrafiltration volume (UFV), and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Compared with peritoneal dialysis (PD), hemodialysis (HD) was associated with greater 24-hour DBPV, reflected by higher DBP standard deviation (SD) (16.1 ± 5.3 vs 13.5 ± 4.5 mmHg) and DBP coefficient of variation (CD) (21.3 ± 5.7% vs 17.9 ± 4.9%). Non-dipping DBPV prevalence was also higher in HD than PD (70.1% vs 53.9%; all p < 0.01).

Among volume indicators, IDWG% showed the strongest correlation with 24-hour DBP SD (r = 0.45). Multivariable analysis showed that dialysis modality (β = 2.31) and IDWG% (β = 1.95) were independently associated with DBP variability (both p < 0.001). A 24-hour DBP SD ≥16 mmHg was independently associated with cardiovascular events (HR = 1.15; 95% CI, 1.08-1.23; p < 0.001), along with HD modality. Targeted volume management was associated with lower DBP variability in HD patients with IDWG% >5%.

These findings indicate an association between dialysis modality, volume status indicators, and DBPV in CKD-G5D. Routine monitoring of DBPV and IDWG% may support cardiovascular risk assessment in dialysis care.