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Abstract: FR-PO278

Prevalence and Prognostic Significance of Systolic Orthostatic Hypotension in CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Rouabhi, Mohamed, Case Western Reserve University, Cleveland, Ohio, United States
  • Al-Kindi, Sadeer, Case Western Reserve University, Cleveland, Ohio, United States
  • Townsend, Raymond R., University of Pennsylvania School of Medicine, Villanova, Pennsylvania, United States
  • Cohen, Jordana B., University of Pennsylvania School of Medicine, Villanova, Pennsylvania, United States
  • Rahman, Mahboob, Case Western Reserve University, Cleveland, Ohio, United States
Background

The prevalence of orthostatic hypotension (OH) and its prognostic significance is not well known in patients with chronic kidney disease (CKD). The aim of this study is to determine the prevalence and clinical factors associated with OH, and whether it is associated with risk of adverse kidney or cardiovascular outcomes in patients with CKD.

Methods

Data from the Chronic Renal Insufficiency Cohort study, a multi-center prospective study of subjects with mild to moderate CKD, were used. OH was defined as ≥20 mmHg decrease in systolic blood pressure in the standing compared to the seated position. Multi-variable logistic regression analyses were performed to identify factors associated with OH. Cox regression analyses were performed to examine the association between OH and renal outcomes (composite of end-stage renal disease [ESRD] and/or 50% decline in GFR), ischemic cardiovascular disease (CVD; composite of myocardial infarction, stroke, or peripheral artery disease), heart failure (HF) and all-cause mortality.

Results

The mean age of the study population (n=3873) was 58.2 (±11 SD) years, and mean estimated GFR was 42.9 ml/min/1.73m2 (±13.5); 48.0% had diabetes. OH was present in 180 (6.9%) patients. In adjusted cross-sectional analyses, Hispanic ethnicity (odds ratio (OR): 1.75, 95% CI: [1.11,2.76]), diabetes (OR: 2.04, 95% CI: [1.37,3.06]), lower body mass index (OR: 0.92, 95% CI: [0.89,0.94] per 1 kg/m2), elevated total cholesterol (OR: 1.01, 95% CI: [1.00,1.01] per 1 mg/dL), and beta-receptor blocker use (OR: 1.51, 95% CI: [1.05,2.2]) were associated with OH. After a median follow up of 8 years, models adjusted for demographic and clinical factors demonstrated that OH was independently associated with higher risk of renal outcomes (hazard ratio [HR]: 1.40, 95% CI: 1.10,1.78), but not ischemic CVD (HR: 1.18, 95% CI: 0.82,1.69), HF (HR: 1.37, 95% CI: 0.93,2.02) or all-cause mortality (HR: 1.00, 95% CI: 0.73,1.37).

Conclusion

Systolic OH was seen in 6.9% of participants in this study population with mild-moderate CKD. Several clinical and demographic factors were associated with higher prevalence of OH. The presence of OH was independently associated with higher risk of adverse renal outcomes, but not ischemic CVD, HF or mortality.

Funding

  • NIDDK Support