Blood Pressure Management in Dialysis: A Comparative Review of Hemodialysis and Peritoneal Dialysis

Hypertension is a major challenge in patients with end-stage kidney disease (ESKD) undergoing dialysis, contributing to increased cardiovascular morbidity and mortality. Both hemodialysis (HD) and peritoneal dialysis (PD) serve as renal replacement therapies, yet their effectiveness in blood pressure (BP) control remains a subject of ongoing debate. Emerging evidence suggests that PD may offer better BP regulation than HD due to continuous ultrafiltration, superior sodium removal, and the preservation of residual kidney function. In contrast, HD is often associated with interdialytic fluid retention, leading to BP fluctuations and a higher risk of cardiovascular complications. However, BP control in PD patients is not without challenges, as ultrafiltration failure, peritoneal membrane dysfunction, and inflammation can contribute to resistant hypertension. Despite these limitations, PD may provide a more stable hemodynamic profile compared to HD, making it a promising option for patients with difficult-to-manage hypertension. Individualized dialysis selection remains crucial, as it balances the benefits of fluid control with the risks of PDrelated complications. Further research, particularly randomized controlled trials, is needed to determine the long-term impact of PD and HD on BP control and cardiovascular outcomes in dialysis patients.