Impaired orthostatic blood pressure stabilization and reduced hemoglobin in chronic kidney disease

Abstract

Impaired orthostatic blood pressure (BP) stabilization is prevalent in patients with chronic kidney disease (CKD) and is associated with adverse outcomes. We aimed to test the hypothesis that reduced hemoglobin is an important contributor to orthostatic intolerance in CKD in the present study. This study included 262 patients with non-dialysis-dependent CKD. Seated and standing BP was measured, and orthostatic BP reduction was calculated for both systolic BP (∆ SBP) and diastolic BP (∆ DBP).The association between orthostatic BP reduction and hemoglobin was determined by multiple linear regression models. We also performed mediation analysis to test to what extent the effect of renal dysfunction on impaired orthostatic BP stabilization can be explained by reduced hemoglobin. The mean age of the patients was 57.7 (±14.5) years, and 61.5% were male. Both ∆ SBP and ∆ DBP correlated negatively with estimated glomerular filtration rate (eGFR). With adjustment for age and sex, hemoglobin level was negatively associated with ∆ SBP (β = −1.4, SE = 0.4, P < .001) and ∆ DBP (β = −0.6, SE = 0.2, P = .009). The associations remained significant with further adjustment for additional covariates. When eGFR was introduced as a covariate, it did not eliminate the significance (both P < .05). The associations remained essentially unchanged in a sensitivity analysis excluding those with concurrent erythropoietin use. Mediation analysis demonstrated that reduced hemoglobin accounted for 35.4% (P = .004) of the effect of eGFR on ∆ SBP and 47.7% (P = .032) on ∆ DBP.Our study suggests that reduced hemoglobin is a potentially important contributor to the development of orthostatic hypotension in CKD. S U PP O RTI N G I N FO R M ATI O NAdditional supporting information may be found online in the Supporting Information section at the end of the article.How to cite this article: Liu W, Wang L, Huang X, He W, Song Z, Yang J. Impaired orthostatic blood pressure stabilization and reduced hemoglobin in chronic kidney disease. J Clin Hypertens.

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

“…Several factors that may contribute to alterations in blood pressure compensation with standing are J o u r n a l P r e -p r o o f present in patients with CKD; these include arterial stiffness, anemia, and impaired autonomic function, among other determinants. [26][27][28] Whether these factors mediate the relationship between orthostatic hypotension and cardiovascular outcomes needs to be evaluated in future studies. As expected, individuals with diabetes have a high prevalence of orthostatic hypotension likely secondary to autonomic neuropathy, and impaired baroreceptor sensitivity.…”

Nomogram prediction model for renal anaemia in IgA nephropathy patients

“…Vascular calcification is also another common complication of CKD [ 33 ]. Liu et al also found that orthostatic hypotension in CKD is closely related to haemoglobin reduction [ 34 ]. Lower ALB, serum CHOL, and TGs are key factors in anaemia and may represent a state of malnutrition in the body, which is also closely related to anaemia because of chronic inflammation in CKD [ 7 , 35 ].…”

Comparative Evaluation of Orthostatic Hypotension in Patients with Diabetic Nephropathy

“…Uric acid is a natural antioxidant compound with beneficial characteristics, but preclinical studies have demonstrated that it is also a proinflammatory compound, and an elevated uric acid level has been found to be associated with the risk of myocardial infarction, stroke, and cardiovascular mortality [18]. On the other hand, OH is already seen at a high rate in CKD patients, and many risk factors in CKD patients, just like DM, can cause arterial stiffness, anemia, impairment of sympathetic nervous system function, and autonomic dysfunction [19,20]. In this study, it was shown for the first time that whether the etiology of CKD is DNP or not does not influence the OH prevalence in these patients.…”