Auricular acupressure for patients with chronic kidney disease undergoing intradialytic hypertension: A systematic review and meta-analysis with trial sequential analysis

Introduction: Chronic kidney disease is a condition with high morbidity and mortality, and long-term renal replacement therapy also increases the risks of intradialytic hypertension. We aimed to evaluate the efficacy and safety of auricular acupressure in patients with chronic kidney disease undergoing intradialytic hypertension, regarding hypertension and reduction of complications of hemodialysis. Methods: Three English and four Chinese databases were searched until September 21st, 2022. Inclusion criteria were auricular acupressure as the only complementary adjuvant in the experimental group and control intervention of blank control. Primary outcomes included systolic blood pressure, diastolic blood pressure, and mean arterial pressure. Risk of bias of the included trials was evaluated using the Cochrane risk-of-bias tool. The review and meta-analyses were conducted using the Cochrane systematic review method, and trial sequential analyses were performed using TSA 0.9. Meta-influence analyses, subgroup analyses, meta-regression, and evaluation of publication bias were performed to explore the heterogeneity. The certainty of evidence was assessed using the GRADE-pro GDT. Results: A total of 17 trials involving 1,288 participants were included. The results showed that auricular acupressure, as a complementary intervention, yielded significantly (p < 0.05) greater reductions in systolic blood pressure (WMD 10.84 mmHg, 95 %CI:9.37-12.32, P < 0.001, I-2=33 %, low certainty), diastolic blood pressure (WMD 8.20 mmHg, 95 %CI:6.36-10.04, P < 0.001, I-2=57 %, very low certainty), and mean arterial pressure (WMD 7.87 mmHg, 95 %CI:5.00-10.74, P < 0.001, I-2 = 0 %, very low certainty) when performed with conventional interventions compared with conventional interventions alone. Results also revealed better relief from hemodialysis complications in the experimental group, including arrhythmias (RR 0.27, 95 %CI:0.16-0.45, P < 0.001, I2=0 %, very low certainty), heart failure (RR 0.38, 95 %CI:0.25-0.59, P < 0.001, I-2 = 0 %, very low certainty), nausea and dizziness (RR 0.51, 95 %CI:0.33-0.77, P = 0.001, I-2 = 0 %, very low certainty), and dizziness alone (RR 0.16, 95 %CI:0.05-0.50, P = 0.002, I-2 = 0 %, low certainty). Conclusion: In general, auricular acupressure is safe and efficacious in patients with chronic kidney disease undergoing intradialytic hypertension, considering reduction in blood pressure and hemodialysis-induced complications. However, limitations of this review include risk of bias (including publication bias) in included studies, and a need for more inclusive studies with longer intervention and follow-up periods, and better global representation.