Aytaş Gamze, Kazancıoğlu Rümeyza, Elçioğlu Ömer C, Gürsu Meltem, Artan A Serra, Yabacı Ayşegül, Soysal Pinar, Bilgi Kadir, Özçelik Semra
Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
Division of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
Kidney Blood Press Res. 2021;46(5):574-580. doi: 10.1159/000517316. Epub 2021 Jul 20.
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.
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.
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).
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.
直立性低血压（OH）影响5% - 20%的人群。我们的研究调查了糖尿病肾病（DNP）患者中OH的存在情况，并与非糖尿病慢性肾病（NDCKD）患者相比，研究了影响OH的因素。
就诊于肾病科门诊的患者，同意参与研究的被纳入。DNP由肾活检和/或临床标准定义。将年龄、性别和估算肾小球滤过率（eGFR）相同的NDCKD患者与DNP患者进行匹配。从病历中获取人口统计学参数和用药情况。OH根据梅奥诊所标准确定。由同一位研究人员使用电子设备测量血压（BP）。所有样本均在同一天采集，并对生化、血液学参数和蛋白尿进行分析。
纳入了112例（51例女性，61例男性，平均年龄：62.56±9.35岁）DNP患者和94例（40例女性，54例男性，平均年龄：62.23±10.08岁）NDCKD患者。DNP组和NDCKD组在OH患病率方面无显著差异（70.5%对61.7%，p = 0.181）。男性患者的OH患病率显著高于女性患者（74.7%对60.0%，p = 0.026）。两组间收缩压变化无显著差异（24.00 [10.00 - 32.00] mmHg对24.00 [13.75 - 30.25] mmHg，p = 0.797），但DNP组舒张压变化显著更高（8.00 [2.00 - 13.00] mmHg对6.00 [2.00 - 9.00] mmHg），p = 0.025）。在DNP组中，有OH的患者尿酸水平显著高于无OH的患者（7.18±1.55对6.36±1.65 mg/dL，p = 0.017）。并且，服用钙通道阻滞剂的患者中有73.7%发生OH（p = 0.015），36例服用α受体阻滞剂的患者中有80.6%发生OH（p = 0.049）。
慢性肾病（CKD）患者中OH患病率非常高，尽管在临床上可能存在有意义的差异，但CKD的病因对OH的发生频率没有统计学上的显著影响。因此，无论是否合并糖尿病，CKD患者都应检查是否存在OH。体位性血压变化的评估应成为肾病科诊疗工作的一部分。
