Orthostatic Hypertension and Hypotension and Outcomes in CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study

Rouabhi, Mohamed; Durieux, Jared; Al‐Kindi, Sadeer G.; Cohen, Jordana B.; Townsend, Raymond R.; Rahman, Mahboob

doi:10.1016/j.xkme.2020.10.012

Cited by 11 publications

(9 citation statements)

References 36 publications

(71 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In an analysis from the CRIC study of 3873 participants, 180 participants (4.6%) had orthostatic hypotension and 81 (2.1%) had orthostatic hypertension. 90 Orthostatic hypotension was associated with high risk for cardiovascular outcomes, including HF, MI, stroke, or PAD (HR, 1.12 [95% CI, 1.03-1.21]), but not kidney outcomes or mortality. Orthostatic hypertension was independently associated with high risk for kidney outcomes, including incident ESRD or 50% decline in eGFR (HR, 1.51 [95% CI, 1.14-1.97]), but not cardiovascular outcomes or mortality.…”

Section: High Blood Pressurementioning

confidence: 99%

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

Tsao¹,

Aday²,

Almarzooq³

et al. 2023

Circulation

2,711

702

View full text Add to dashboard Cite

BACKGROUND: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS: The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year’s worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year’s edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS: Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS: The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

show abstract

Section: High Blood Pressurementioning

confidence: 99%

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

Tsao¹,

Aday²,

Almarzooq³

et al. 2023

Circulation

2,711

702

View full text Add to dashboard Cite

show abstract

“…It should be noted at this point that in this study, we found the prevalence of OH in CKD patients to be much higher than that found in some of the studies in the literature which we believe arises from measurement methods. While the first BP measurements were made while the patients were in a supine position in this study, many of the said studies have made their first measurements while the patients were in seated positions [21]. We should also note that ethnicity of the study population may also be a factor in OH prevalence, which has been shown by previous studies to be so [22].…”

Section: Discussionmentioning

confidence: 81%

Comparative Evaluation of Orthostatic Hypotension in Patients with Diabetic Nephropathy

Aytaş

Kazancıoğlu

Elçioğlu

et al. 2021

Kidney Blood Press Res

View full text Add to dashboard Cite

Introduction: Orthostatic hypotension (OH) affects 5–20% of the population. Our study investigates the presence of OH in diabetic nephropathy (DNP) patients and the factors affecting OH in comparison with nondiabetic chronic kidney disease (NDCKD) patients. Method: Patients presented to the nephrology clinic, and those who consented were included in the study. DNP was defined by kidney biopsy and/or clinical criteria. NDCKD patients of the same sex, age, and eGFR were matched to DNP patients. Demographic parameters and medications were obtained from the records. OH was determined by Mayo clinic criteria. The same researcher used an electronic device to measure blood pressure (BP). All samples were taken and analyzed the same day for biochemical and hematologic parameters and albuminuria. Results: 112 (51 F, 61 M, mean age: 62.56 ± 9.35 years) DNP and 94 (40 F, 54 M, mean age: 62.23 ± 10.08 years) NDCKD patients were included. There was no significant difference between DNP and NDCKD groups in terms of OH prevalence (70.5 vs. 61.7%, p = 0.181). Male patients had significantly higher OH prevalence than female patients (74.7 vs. 60.0%, p = 0.026). There was no significant difference in change in systolic BP between the groups (24.00 [10.00–32.00] mm Hg vs. 24.00 [13.75–30.25] mm Hg, p = 0.797), but the change in diastolic BP was significantly higher in the DNP group (8.00 [2.00–13.00] mm Hg vs. 6.00 [2.00–9.00] mm Hg, p = 0.025). In the DNP group, patients with OH had significantly higher uric acid levels than those without OH (7.18 ± 1.55 vs. 6.36 ± 1.65 mg/dL, p = 0.017). And, 73.7% of patients on calcium channel blockers developed OH (p = 0.015), and OH developed in 80.6% of 36 patients on alpha-blockers (p = 0.049). Conclusion: OH prevalence is very high in CKD, and etiology of CKD does not have a statistically significant effect on the frequency of OH, despite a difference that could be meaningful clinically. Therefore, patients with CKD are checked for OH, with or without concurrent diabetes mellitus. Evaluation of postural BP changes should be a part of nephrology practice.

show abstract

“…A large population-based cohort study demonstrated that OH was associated with the development of incident CKD defined as eGFR of <60 mL/min/1.73 m 2 or a coded hospitalization or death for CKD [29]. Conversely, OH in a study of patients with CKD was not associated with kidney outcomes defined as the development of end-stage kidney disease or a 50% decline in eGFR [26]. Inconsistent with previous studies, the present study showed that classic OH was associated with not only an overall decline in kidney function for 12 years but also a risk of 30% decline in kidney function from baseline.…”

Section: Discussionmentioning

confidence: 99%

“…The occurrence of OH may decrease renal perfusion and intraglomerular pressure, resulting in kidney damage [24]. However, the association between OH and renal function has not been sufficiently investigated and remains controversial [25, 26]. Hence, we sought to examine the association between classic OH and long-term changes in kidney function in the general population.…”

Section: Introductionmentioning

confidence: 99%

Effect of Orthostatic Hypotension on Kidney Function

Kim

Lee

2023

Nephron

View full text Add to dashboard Cite

Background: The association between orthostatic hypotension (OH) and long-term changes in kidney function in the general population is not yet well known. Methods: We performed a population-based cohort study based on data from the Korean Genome and Epidemiology Study (KoGES). The primary exposure was the presence of classic OH, defined as a postural drop in blood pressure (systolic blood pressure ≥20 mm Hg and/or diastolic blood pressure ≥10 mm Hg) at 2 min of standing after 5 min of supine rest. The primary outcome was a 12-year change in kidney function, assessed by subtracting the baseline estimated glomerular filtration rate (eGFR) from the eGFR at 12 years of follow-up. Results: Our study included 5,905 participants (median [interquartile range] age, 49 [44–58] years; 46% males) who met inclusion and exclusion criteria. Classic OH was detected in 268 (4.5%) of the total participants. In the regression analyses, participants with classic OH had a greater decline in eGFR over 12 years compared with those without classic OH; the fully adjusted beta coefficient and 95% confidence intervals (95% CIs) were −1.74 (−3.07, −0.40). Furthermore, classic OH was associated with 27% greater risk of a 30% decline in kidney function compared with those without classic OH; fully adjusted hazard ratio and 95% CIs were 1.27 (1.07, 1.49). Conclusions: Classic OH can negatively affect long-term kidney function in the general population.

show abstract

Orthostatic Hypertension and Hypotension and Outcomes in CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study

Cited by 11 publications

References 36 publications

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

Comparative Evaluation of Orthostatic Hypotension in Patients with Diabetic Nephropathy

Effect of Orthostatic Hypotension on Kidney Function

Contact Info

Product

Resources

About