Race and sex differences in pressor response to laboratory stressors in patients with chronic kidney disease.

Black individuals, especially Black females, have higher prevalence of chronic kidney disease (CKD) and greater risk of CKD-related cardiovascular (CV) mortality compared with other racial groups. Patients with CKD have higher CV reactivity compared with those without CKD that contributes to increased CV risk in this patient population. However, race and sex differences in hemodynamic reactivity within CKD have not previously been explored. Given the known race and sex differences in the risk of CKD-related CV disease, we tested the hypothesis that Black individuals, especially Black females, with CKD will have greater CV reactivity to stress. Forty-three Black participants (32 males) and 20 White participants (12 males) with CKD stages III and IV were enrolled. Blood pressure (BP) and heart rate (HR) reactivity were evaluated during three laboratory stressors: mental arithmetic test (MAT), static handgrip exercise (SHG30%), and cold pressor test (CPT). Black participants had greater BP reactivity during MAT and greater HR reactivity during SHG30%, but no difference in CV reactivity during CPT compared with White participants. There were no sex differences in hemodynamic responses across all tests. Black females had greater BP reactivity during MAT and greater HR reactivity during SHG30% compared with White females. Black females had the highest CV responses across all tests. Black individuals, especially Black females, with CKD had greater CV reactivity during stressful stimuli compared with White individuals with CKD. These results highlight demographic influences on CV reactivity that may contribute to differences in CV outcomes in people with CKD. Among patients with chronic kidney disease, Black individuals-particularly Black females-exhibited heightened cardiovascular responses to different laboratory stressors compared with White individuals. The magnitude and pattern of cardiovascular reactivity varied by race and sex, with differential responses observed depending on the type of stressor applied. Elevated cardiovascular reactivity in Black individuals, especially Black females, may represent a mechanistic link contributing to their disproportionate burden of CKD-related cardiovascular disease.