Chronic kidney disease and orthostatic hypotension in hospitalised older adults

Figures & data

Table 1. Clinical and biochemical characteristics stratified for orthostatic hypotension and chronic kidney disease.

Variable	All (n = 174)	Orthostatic hypotension (OH)		Chronic Kidney Disease (CKD)
		OH−(n = 94)	OH+(n = 80)	CKD-(n = 76)	CKD+(n = 98)
Chronic Kidney Disease (%)	56.3	48.9	65.0	---	---
Orthostatic Hypotension (%)	46.0	---	---	36.8	53.1
Age (years, mean±SD)	74.4 ± 7.0	74.1 ± 7.0	74.8 ± 7.0	71.6 ± 7.2	76.6 ± 6.2*
Sex, Female (%)	58.6	53.2	65.0	60.5	57.1
Body Mass Index (kg/m^2, mean±SD)	28.3 ± 4.6	27.7 ± 4.8	29.2 ± 4.3*	28.0 ± 5.2	28.7 ± 4.2
Number of diseases (mean±SD)	3.0 ± 1.9	3.1 ± 2.0	2.9 ± 1.9	2.5 ± 1.8	3.4 ± 2.0*
eGFR (mL/min/1.73 m^2, mean±SD)	58.8 ± 16.4	61.1 ± 15.9	56.1 ± 16.7*	73.2 ± 11.9	47.6 ± 9.2*
Hypertension (%)	66.7	67.0	66.3	55.9	73.5*
Coronary Artery Disease (%)	35.1	39.4	30.0	28.9	39.8
Acute Myocardial Infarction (%)	23.6	26.6	20.0	21.1	25.5
Diabetes (%)	27.6	26.6	28.8	25.0	29.6
Heart Failure (%)	20.1	23.4	16.3	13.2	25.5*
Cardiac Valve Diseases (%)	16.7	20.2	12.5	17.1	16.3
Atrial fibrillation (%)	16.1	20.2	11.3	11.8	19.4
ICD (%)	10.9	9.6	12.5	5.3	15.3*
Pacemaker (%)	8.6	8.5	8.8	3.9	12.2*
Creatinine (mg/dL, mean±SD)	1.0 ± 0.78	1.0 ± 0.4	1.2 ± 1.1	0.8 ± 0.2	1.3 ± 1.0
Blood Urea Nitrogen (mg/dL, mean±SD)	48.±20	45 ± 19	51 ± 21	39 ± 9	56 ± 22.6*
Uric acid (mg/dL, mean±SD)	5.6 ± 1.7	5.5 ± 1.8	5.8 ± 1.7	4.9 ± 1.2	6.1 ± 1.9*
Glucose (mg/dL, mean±SD)	107 ± 24	111 ± 27	104 ± 18	109 ± 24.	105 ± 22.5
Total protein (g/dL, mean±SD)	6.7 ± 0.6	6.8 ± 0.60	6.8 ± 0.6	6.8 ± 0.5	6.8 ± 0.6
Total bilirubin (mg/dL, mean±SD)	0.7 ± 0.3	0.7 ± 0.3	0.7 ± 0.4	0.7 ± 0.4	0.6 ± 0.4
Sodium (mEq/L, mean±SD)	142.1 ± 2.3	141.9 ± 2.3	142.5 ± 2.4	142.1 ± 2.2	142.2 ± 2.4
Potassium (mEq/L, mean±SD)	4.3 ± 0.36	4.4 ± 0.3	4.4 ± 0.4	4.3 ± 0.3	4.5 ± 0.4*
C-reactive protein (mg/L, mean±SD)	1.0 ± 1.9	1.3 ± 2.0	0.7 ± 1.7	1.1 ± 1.9	1.0 ± 1.6
Red Blood Cells (n × 10^3/mm^3, mean±SD)	4428 ± 678	4393 ± 728	4476 ± 616	4478 ± 640	4390 ± 709
Haemoglobin (g/dL, mean±SD)	12.6 ± 1.6	12.6 ± 1.7	12.7 ± 1.6	12.9 ± 1.7	11.5 ± 1.6
Haematocrit (%, mean±SD)	38.6 ± 4.8	38.2 ± 4.9	35.2 ± 4.7	38.6 ± 5.0	37.7 ± 4.8

Legend. ICD: Implantable Cardioverter Defibrillator.

*p < 0.05 vs OH − or RFi.

Table 2. Drugs assumption stratified for orthostatic hypotension and chronic kidney disease.

Drug (%)	All (n = 174)	Orthostatic Hypotension (OH)		Chronic Kidney Disease (CKD)
		OH−(n = 94)	OH+(n = 80)	CKD−(n = 76)	CKD+(n = 98)
Proton-pump inhibitor	68.4	72.8	62.3	65.3	70.8
Furosemide	37.4	44.6	29.0*	25.3	46.9*
Hydrochlorothiazide	17.5	15.2	20.3	18.7	16.7
Spironolactone	14.1	19.6	7.7*	9.5	17.7
ACE-inhibitors	35.1	39.1	30.4	30.7	38.5
ARBs	23.4	25	21.5	20	26
Beta-blockers	50.9	52.2	49.4	44.0	56.3
Alpha-blockers	6.4	4.3	8.9	9.3	4.2
Nitrates	27.6	31.5	23.1	18.7	34.7*
Digitalis	4.1	4.3	3.8	4	4.2
Calcium antagonists	15.2	12.0	19.0	14.7	15.6
Amiodarone	12.3	15.2	9.9	9.3	14.6
Antiarrhythmics	14.6	15.2	13.9	9.3	18.8
Salicylates	32.4	36.3	27.8	32	32.6
Ticlopidine	5.3	3.1	8.1	1.3	8.3
Clopidogrel	3.6	5.4	1.4	4.1	3.3
Anticoagulant	26.3	29.3	22.8	20	31.3
Statins	41.5	42.4	40.5	36.0	45.8
Allopurinol	19.9	21.7	17.7	9.3	28.1*
Insulin	7.0	10.9	6.5	9.3	5.2
Hypoglycaemic agents	14.6	14.1	15.1	13.5	15.6
Benzodiazepines	37.4	32.6	43	33.3	40.6
Antidepressive agents	10.8	7.6	14.9	9.5	12.0
Tramadol	4.3	1.1	10.9*	3.3	5.1
Corticosteroids	4.7	7.6	1.5	5.3	4.2
Calcium	15.8	16.3	15.2	12	18.8
NSAID	11.7	7.6	16.9	13.7	10

Legend. ACE: Angiotensin Converting Enzyme; ARBs: Angiotensin Receptor Blockers; NSAID: Non-Steroidal Anti-Inflammatory Drugs.

*p < 0.05 vs. OH − or RFi.

Figure 1. Difference of heart rate (A), systolic (B) and diastolic (C) blood pressure at 0’, 1’, 3’ and 5’ minutes from lying to standing position among all patients and in patients without (OH−) and with (OH+) orthostatic hypotension (*p < 0.05 OH + vs. OH−).

Figure 2. Difference of heart rate (A), systolic (B) and diastolic (C) blood pressure at 0’, 1’, 3’ and 5’ minutes from lying to standing position among all patients and in patients without (CKD−) and with (CKD+) chronic kidney disease (*p < 0.05 CKD + vs. CKD−).

Table 3. Multivariate binary logistic regression analysis on orthostatic hypotension.

Variable	OR	95 % CI	p
Chronic Kidney Disease	2.426	1.192–4.937	0.014
BMI	1.082	1.004–1.165	0.039
Age	1.001	0.956–1.048	0.960
Female Sex	0.729	0.361–1.468	0.376
Diabetes	1.422	0.667–3.033	0.362
Furosemide	0.477	0.204–1.115	0.088
Spironolactone	0.424	0.123–1.460	0.174
Tramadol	8.130	0.832–79.492	0.072

Legend. OR: Odds Ratio; CI: Confidence interval; Chronic Kidney Disease: estimated Glomerular Filtration Rate < 60 mL/min/1.73 m²; BMI: Body Mass Index.

Data availability statement

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