To date, little is known regarding the treatment effects of different timed-dosing antihypertensive medications among hypertensive patients with albuminuria. We aimed to investigate whether morning or evening dosing of antihypertensive medication differentially affects early changes in albuminuria.We conducted an open-label, single-center, assessor-masked, parallel-group, pilot randomized controlled trial among adult hypertensive patients with albuminuria (urinary albumin‒creatinine ratio [UACR] ≥ 30 mg/g) receiving at least one antihypertensive medication. The participants were assigned (1:1) to receive antihypertensive medications either in the morning (6:00-10:00 AM) or in the evening (6:00-10:00 PM), with a treatment follow-up at 3 months. The primary outcome was the change in the log UACR. The secondary outcomes were changes in blood pressure and kidney function. Post hoc outcomes included clinically meaningful control of outcomes.Among the 60 participants enrolled (mean age, 65.6 years; proportion of females, 51.7%; median UACR, 116.1 mg/g), 58 patients completed the trial. The absolute changes in log UACR over 3 months were - 0.21 (95% CI, -0.40 to -0.03; n = 31) for morning-dosing and - 0.22 (95% CI, -0.46 to 0.01; n = 27) for evening-dosing, with an adjusted difference of -0.01 (95% CI, -0.32 to 0.30; P = 0.955) between the groups. No statistically significant difference was observed for secondary and post hoc outcomes. No safety profile concerns were identified. Among hypertensive patients with albuminuria, chronotherapy, whether administered in the morning or evening, did not affect early treatment outcomes in terms of the UACR, blood pressure, or kidney function. Trial registration: Thai Clinical Trials Registry (TCTR); TCTR20240930002; Registration date: 30/09/2024; retrospectively registered.

Background/Objectives: Since peritoneal dialysis (PD) has been used in nephrology practice for several decades, contemporary evidence on global, regional, and country incidence rates of PD-associated peritonitis has not been comprehensively synthesized. We performed a systematic review and meta-analysis to estimate the incidence rates of PD-associated peritonitis worldwide in contemporary PD practice. Methods: We systematically searched 6 electronic databases to identify all relevant English-language articles that reported rates of PD-associated peritonitis according to International Society for Peritoneal Dialysis (ISPD) criteria, regardless of age, sex, or PD modality, from 2011 to 2026. We used a random-effects meta-analysis to estimate the pooled incidence rate (episodes per patient-year), with corresponding 95% confidence intervals. We reported summary incidence rates of PD-associated peritonitis for the global estimation (overall rate), World Health Organization (WHO) region, and each country. We also estimated meta-syntheses by causative microorganism of PD-associated peritonitis. Results: We identified 12,364 records, of which 153 unique study populations of PD patients fulfilled the study selection criteria. These included over 132,000 PD patients from 37 countries worldwide. Despite substantial heterogeneity, the global incidence rate estimate of PD-associated peritonitis was 0.31 (0.28–0.34) episodes per patient-year (total peritonitis episodes, 88,769; total patient-years at risk, 264,296.30). According to WHO region (p for difference between regions 0.40 episodes per patient-year. Regarding the causative microorganisms of PD-associated peritonitis, Gram-positive bacteria had the highest pooled incidence rate of PD-associated peritonitis (0.127 [0.113–0.142]), followed by culture-negative (0.073 [0.065–0.083]), Gram-negative bacteria (0.065 [0.058–0.073]), polymicrobial (0.017 [0.014–0.021]), fungus (0.009 [0.008–0.011]), and Mycobacterium (0.004 [0.003–0.006]). Conclusions: These global estimates of PD-associated peritonitis incidence rates demonstrated variation across regions and countries. Given differences in healthcare systems across countries, sharing innovations and knowledge for continuous quality improvement and standardizing and harmonizing PD practice settings are warranted to improve quality indicators and patient well-being and reduce inequalities in PD management worldwide.