Chronic kidney disease and orthostatic hypotension in hospitalised older adults

Abstract

Purpose

Orthostatic hypotension (OH) may predispose older adults to health complications leading to functional impairment. Despite the central role of the kidney in blood pressure control, the contribution of renal function in orthostatic hypotension is poorly investigated. To verify the association between Chronic Kidney Disease (CKD) and OH a population of hospitalised elderly patients with comorbidities was studied.

Materials and methods

174 patients were consecutively admitted to Acute Geriatric Wards. On admission, patients underwent postural systolic (SBP) and diastolic (DBP) blood pressure evaluation by automatic oscillometric device after 10 min rest in lying position, and in standing position at time 0, 1, 3 and 5 min. CKD was assumed for estimated glomerular filtration rate (e-GFR) less than 60 mL/min/1.73 m².

Results

The mean age of the population enrolled was 74.4 ± 7.0. OH was found in 46.0% and CKD in 56.3% of patients, respectively. A lower e-GFR was observed in patients with (56.1 ± 16.7 mL/min/1.73 m²) than in those without OH (61.1 ± 15.9 mL/min/1.73 m²) (p < 0.05). A greater fall in SBP at 0-min (12.8 ± 6.3 vs. 7.7 ± 3.2 mmHg) and at 1-min (8.4 ± 4.5 vs. 5.7 ± 2.8 mmHg) was found in CKD patients in respect to patients without CKD during active standing test (p < 0.05). Similarly, a DBP reduction at 0-min and at 1-min was observed in CKD patients in respect to patients without CKD (p < 0.05). A multivariate logistic regression analysis showed that CKD was associated to OH (OR 2.426; 95%CI 1.192–4.937; p = 0.014).

Conclusions

CKD is associated to OH in hospitalised older adults.

PLAIN LANGUAGE SUMMARY

Keywords:

• Orthostatic hypotension
• chronic kidney disease
• older adults
• comorbidity
• estimated glomerular filtration rate

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical statement

The present study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the University of Naples Federico II “Carlo Romano” (reg. n. 25/12). Each participant signed a written informed consent form.

Data availability statement

The datasets used or analysed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

European Union - NextGenerationEU - AGE-It Spoke 3.