Factors associated with vascular calcification in peritoneal dialysis patients: a meta-analysis

Peritoneal dialysis (PD) is a core renal replacement therapy for end-stage renal disease (ESRD), but PD patients face elevated cardiovascular risk, with vascular calcification (VC) severely impairing long-term prognosis. This meta-analysis aimed to synthesize factors associated with VC in PD patients to support early risk stratification and targeted clinical management.

We searched the Cochrane Library, Web of Science, PubMed, and Embase up to June 30, 2026, for English studies on factors associated with VC in PD patients. Study quality was assessed via the Newcastle-Ottawa Scale, and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. The protocol was registered (CRD420251241785).

Twenty-nine studies (3,696 PD patients) were included. Factors significantly associated with VC included: age (OR 1.09, 95% CI 1.07-1.11, P < 0.001), diabetes (OR 5.21, 95% CI 3.73-7.28, P < 0.001), hypertension (OR 5.29, 95% CI 1.70-16.48, P < 0.001), low vitamin D (OR 0.52, 95% CI 0.30-0.91, P = 0.02), low albumin (OR 0.93, 95% CI 0.90-0.97, P < 0.001), elevated alkaline phosphatase (OR 2.92, 95% CI 2.90-2.95, P < 0.001), HbA1c (OR 2.59, 95% CI 1.89-3.55, P < 0.001), dialysis duration (OR 1.04, 95% CI 1.01-1.07, P = 0.01), and lipid-lowering agent use (OR 2.26, 95% CI 1.31-3.91, P < 0.001), among others.

Multiple clinical and biochemical factors are associated with VC in PD patients. These findings offer useful evidence for early identification of high-risk patients and tailored management, with further large-scale prospective studies needed for validation.