National survey of blood pressure management practices in peritoneal dialysis.

BACKGROUND

Contemporary practices for blood pressure (BP) management in peritoneal dialysis (PD) remain poorly characterized despite cardiovascular disease and hypertension being highly prevalent in patients on PD.

METHODS

We conducted a national survey of nephrologists in the United States with publicly available email addresses affiliated with the 150 ACGME-accredited adult nephrology training programs. Email invitations were sent to 1786 nephrologists between January and February 2026. 100 nephrologists actively caring for patients on PD consented and completed the survey.

RESULTS

We found wide variation in BP management practices amongst nephrologists. 68% nephrologists use both home and clinic BP measurements to guide treatment decisions, while 32% rely primarily on home BP. Involvement in patient education regarding BP measurement technique was inconsistent. About 25% nephrologists had minimal or no involvement, and 48% had partial involvement with staff-led education. Knowledge about the patient's home BP device or cuff placement was also limited. The target systolic BP used by nephrologists for patients on PD varied, ranging from < 110 to < 160 mmHg.

CONCLUSIONS

Although clinic BP has served as the primary basis for epidemiologic studies linking BP with adverse outcomes in PD, real-world practice appears to depend heavily on home BP measurements. This reliance occurs despite variable oversight of home BP measurement technique among US nephrologists caring for patients on PD. These findings highlight a disconnect between the evidence base and clinical practice. Prospective studies are needed to determine whether home BP-guided management improves outcomes and to define optimal BP targets in PD.