{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T18:21:43Z","timestamp":1790878903135,"version":"4.1.0"},"reference-count":52,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T00:00:00Z","timestamp":1626048000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Blood pressure changes upon standing reflect a hemodynamic response, which depends on the baroreflex system and euvolemia. Dysautonomia and fluctuations in blood volume are hallmarks in kidney failure requiring replacement therapy. Orthostatic hypotension has been associated with mortality in hemodialysis patients, but neither this relationship nor the impact of changes in blood pressure has been tested in patients on peritoneal dialysis. We investigated both these relationships in a cohort of 137 PD patients. The response to orthostasis was assessed according to a standardized protocol. Twenty-five patients (18%) had systolic orthostatic hypotension, and 17 patients (12%) had diastolic hypotension. The magnitude of systolic and diastolic BP changes was inversely related to the value of the corresponding supine BP component (r\u00a0= \u22120.16, p = 0.056 (systolic) and r\u00a0= \u22120.25, p = 0.003 (diastolic), respectively). Orthostatic changes in diastolic, but not in systolic, BP were linearly related to the death risk (HR (1 mmHg reduction): 1.04, 95% CI 1.01\u20131.07, p = 0.006), and this was also true for CV death (HR: 1.08, 95% CI 1.03\u20131.12, p = 0.001). The strength of this association was not affected by further data adjustment (p \u2264 0.05). These findings suggest that independent of the formal diagnosis of orthostatic hypotension, even minor orthostatic reductions in diastolic BP bear an excess death risk in this population.<\/jats:p>","DOI":"10.3390\/jcm10143075","type":"journal-article","created":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T21:56:37Z","timestamp":1626126997000},"page":"3075","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical Epidemiology of Systolic and Diastolic Orthostatic Hypotension in Patients on Peritoneal Dialysis"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4967-0916","authenticated-orcid":false,"given":"Claudia","family":"Torino","sequence":"first","affiliation":[{"name":"National Research Council\u2014Institute of Clinical Physiology, Via Vallone Petrara snc, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocco","family":"Tripepi","sequence":"additional","affiliation":[{"name":"National Research Council\u2014Institute of Clinical Physiology, Via Vallone Petrara snc, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Carmela","family":"Versace","sequence":"additional","affiliation":[{"name":"National Research Council\u2014Institute of Clinical Physiology, Via Vallone Petrara snc, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Vilasi","sequence":"additional","affiliation":[{"name":"National Research Council\u2014Institute of Clinical Physiology, Via Vallone Petrara snc, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Tripepi","sequence":"additional","affiliation":[{"name":"National Research Council\u2014Institute of Clinical Physiology, Via Vallone Petrara snc, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Panuccio","sequence":"additional","affiliation":[{"name":"Nephology, Dialysis and Transplantation Unit\u2014GOM \u201cBianchi-Melacrino-Morelli\u201d, Via Vallone Petrara snc, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"281","DOI":"10.4103\/2230-8210.86860","article-title":"Neuro-endocrine regulation of blood pressure","volume":"15","author":"Sandeep","year":"2011","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1475-925X-9-4","article-title":"Neural set point for the control of arterial pressure: Role of the nucleus tractus solitarius","volume":"9","author":"Zanutto","year":"2010","journal-title":"Biomed. Eng. Online"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1046\/j.1440-1681.2002.03640.x","article-title":"Central mechanisms underlying short- and long-term regulation of the cardiovascular system","volume":"29","author":"Dampney","year":"2002","journal-title":"Clin. Exp. Pharmacol. Physiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/0165-1838(92)90121-V","article-title":"Specialized functional pathways are the building blocks of the autonomic nervous system","volume":"41","author":"McLachlan","year":"1992","journal-title":"J. Auton. Nerv. Syst."},{"key":"ref_5","unstructured":"Goodman, H. (2003). Basic Medical Endocrinology, Academic Press. [3rd ed.]."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1111\/j.1440-1681.1996.tb01765.x","article-title":"Neurohumoral activation in heart failure: Role of paraventricular nucleus","volume":"23","author":"Patel","year":"1996","journal-title":"Clin. Exp. Pharmacol. Physiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/S0361-9230(00)00311-7","article-title":"Hypothalamus, hypertension, and exercise","volume":"53","author":"Kramer","year":"2000","journal-title":"Brain Res. Bull."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1038\/nrneph.2012.191","article-title":"The role of the kidney in regulating arterial blood pressure","volume":"8","author":"Wadei","year":"2012","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1002\/cphy.c100053","article-title":"The Kallikrein-Kinin system as a regulator of cardiovascular and renal function","volume":"1","author":"Rhaleb","year":"2011","journal-title":"Compr. Physiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1073\/pnas.14.1.94","article-title":"The Effect of Posture upon the Composition and Volume of the Blood in Man","volume":"14","author":"Thompson","year":"1928","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_11","first-page":"8458","article-title":"Autonomic dysfunction in kidney diseases","volume":"24","author":"Lai","year":"2020","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1159\/000183828","article-title":"Chronic renal failure and cardiovascular autonomic function","volume":"43","author":"Malik","year":"1986","journal-title":"Nephron"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1038\/ki.1991.28","article-title":"Dialysis hypotension: A hemodynamic analysis","volume":"39","author":"Daugirdas","year":"1991","journal-title":"Kidney Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1038\/sj.ki.5000417","article-title":"Traditional and emerging cardiovascular and renal risk factors: An epidemiologic perspective","volume":"70","author":"Zoccali","year":"2006","journal-title":"Kidney Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2965","DOI":"10.1093\/ndt\/gfn228","article-title":"Towards improved cardiovascular management: The necessity of combining blood pressure and fluid overload","volume":"23","author":"Wabel","year":"2008","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.1093\/ndt\/gfy083","article-title":"Greater fluid overload and lower interdialytic weight gain are independently associated with mortality in a large international hemodialysis population","volume":"33","author":"Hecking","year":"2018","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1056\/NEJM197702102960601","article-title":"The defect in primary orthostatic hypotension","volume":"296","author":"Ziegler","year":"1977","journal-title":"N. Engl. J. Med."},{"key":"ref_18","unstructured":"Ensrud, K., Nevitt, M., Yunis, C., Hulley, S., Grimm, R., and Cumming, S. (2021, April 13). Postural Hypotension and Postural Dizziness in Elderly Women. The Study of Osteoporotic Fractures. The Study of Osteoporotic Fractures Research Group\u2014PubMed, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/1580709\/."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/S0895-7061(99)00257-5","article-title":"Orthostatic hypotension and the incidence of coronary heart disease: The atherosclerosis risk in communities study","volume":"13","author":"Rose","year":"2000","journal-title":"Am. J. Hypertens."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1093\/eurheartj\/ehp329","article-title":"Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malm\u00f6 Preventive Project)","volume":"31","author":"Fedorowski","year":"2010","journal-title":"Eur. Heart J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1111\/j.1365-2796.2010.02261.x","article-title":"Orthostatic hypotension and long-term incidence of atrial fibrillation: The malm\u00f6 preventive project: Original Article","volume":"268","author":"Fedorowski","year":"2010","journal-title":"J. Intern. Med."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Agarwal, S.K., Alonso, A., Whelton, S.P., Soliman, E.Z., Rose, K.M., Chamberlain, A.M., Simpson, R.J., Coresh, J., and Heiss, G. (2013). Orthostatic change in blood pressure and incidence of atrial fibrillation: Results from a bi-ethnic population based study. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0079030"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Xin, W., Lin, Z., and Li, X. (2013). Orthostatic Hypotension and the Risk of Congestive Heart Failure: A Meta-Analysis of Prospective Cohort Studies. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0063169"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1038\/ajh.2010.150","article-title":"Orthostatic hypotension predicts incidence of heart failure: The malm\u00f6 preventive project","volume":"23","author":"Fedorowski","year":"2010","journal-title":"Am. J. Hypertens."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2307","DOI":"10.1161\/01.STR.31.10.2307","article-title":"Orthostatic hypotension as a risk factor for stroke: The Atherosclerosis Risk in Communities (ARIC) study, 1987\u20131996","volume":"31","author":"Eigenbrodt","year":"2000","journal-title":"Stroke"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1562","DOI":"10.1097\/HJH.0000000000000235","article-title":"Association between orthostatic hypotension and cardiovascular risk, cerebrovascular risk, cognitive decline and falls as well as overall mortality: A systematic review and meta-analysis","volume":"32","author":"Angelousi","year":"2014","journal-title":"J. Hypertens."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1136\/heartjnl-2013-304121","article-title":"Orthostatic hypotension and mortality risk: A meta-analysis of cohort studies","volume":"100","author":"Xin","year":"2014","journal-title":"Heart"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1111\/j.1523-1755.2004.00812.x","article-title":"Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients","volume":"66","author":"Shoji","year":"2004","journal-title":"Kidney Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3021","DOI":"10.1093\/eurheartj\/ehy339","article-title":"2018 ESC\/ESH Guidelines for themanagement of arterial hypertension","volume":"39","author":"Williams","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1002\/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO;2-4","article-title":"Tutorial in Biostatistics: Multivariable prognostic models: Issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors","volume":"15","author":"Harrell","year":"1996","journal-title":"Stat. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1111\/j.1445-5994.1990.tb01315.x","article-title":"The effect of ageing on autonomic nervous system function","volume":"20","author":"Ingall","year":"1990","journal-title":"Aust. N. Z. J. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1702","DOI":"10.1093\/ndt\/13.7.1702","article-title":"Prevalence of central autonomic neuropathy in elderly dialysis patients","volume":"13","author":"Jassal","year":"1998","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.2337\/diacare.26.5.1553","article-title":"Diabetic autonomic neuropathy","volume":"26","author":"Vinik","year":"2003","journal-title":"Diabetes Care"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1007\/s10286-007-1001-3","article-title":"Prevalence of orthostatic hypotension","volume":"18","author":"Low","year":"2008","journal-title":"Clin. Auton. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s10286-011-0119-5","article-title":"Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome","volume":"21","author":"Freeman","year":"2011","journal-title":"Clin. Auton. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1097\/HJH.0b013e32834d3d73","article-title":"Orthostatic hypotension in very old individuals living in nursing homes: The PARTAGE study","volume":"30","author":"Valbusa","year":"2012","journal-title":"J. Hypertens."},{"key":"ref_37","first-page":"72","article-title":"Orthostatic Blood Pressure (BP) Variance in a Chronic Kidney Disease (CKD) Clinic","volume":"15","author":"Bhat","year":"2013","journal-title":"J. Clin. Hypertens."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1016\/0895-7061(96)00151-3","article-title":"Factors associated with orthostatic hypotension in the Chinese population in Taiwan","volume":"9","author":"Wu","year":"1996","journal-title":"Am. J. Hypertens."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1161\/HYPERTENSIONAHA.116.07474","article-title":"Orthostatic Hypotension in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) Blood Pressure Trial: Prevalence, Incidence, and Prognostic Significance","volume":"68","author":"Fleg","year":"2016","journal-title":"Hypertension"},{"key":"ref_40","first-page":"182","article-title":"Orthostatic hypotension in the elderly: Aetiology, manifestations andmanagement","volume":"27","author":"Dey","year":"1998","journal-title":"J. Ir. Coll. Physicians Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1161\/HYPERTENSIONAHA.110.156380","article-title":"Orthostatic hypotension and incident chronic kidney disease: The atherosclerosis risk in communities study","volume":"56","author":"Franceschini","year":"2010","journal-title":"Hypertension"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1093\/ndt\/gfh614","article-title":"Orthostatic hypotension at the introductory phase of haemodialysis predicts all-cause mortality","volume":"20","author":"Sasaki","year":"2005","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Musso, G., Gambino, R., Tabibian, J.H., Ekstedt, M., Kechagias, S., Hamaguchi, M., Hultcrantz, R., Hagstr\u00f6m, H., Yoon, S.K., and Charatcharoenwitthaya, P. (2014). Association of Non-alcoholic Fatty Liver Disease with Chronic Kidney Disease: A Systematic Review and Meta-analysis. PLoS Med., 11.","DOI":"10.1371\/journal.pmed.1001680"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Juraschek, S.P., Daya, N., Appel, L.J., Miller, E.R., McEvoy, J.W., Matsushita, K., Ballantyne, C.M., and Selvin, E. (2018). Orthostatic hypotension and risk of clinical and subclinical cardiovascular disease in middle-aged adults. J. Am. Heart Assoc., 7.","DOI":"10.1161\/JAHA.118.008884"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1111\/jch.12726","article-title":"Arterial Stiffness, Central Pulsatile Hemodynamic Load, and Orthostatic Hypotension","volume":"18","author":"Liu","year":"2016","journal-title":"J. Clin. Hypertens."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1007\/s40620-019-00655-6","article-title":"Aortic stiffness and central systolic pressure are associated with ambulatory orthostatic BP fall in chronic kidney disease","volume":"33","author":"Kirkham","year":"2020","journal-title":"J. Nephrol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1093\/ndt\/16.7.1459","article-title":"Long-term CAPD patients are volume expanded and display more severe left ventricular hypertrophy than haemodialysis patients","volume":"16","author":"Enia","year":"2001","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1111\/j.1525-1594.1979.tb01050.x","article-title":"Hemodynamic Studies in Long-Term Peritoneal Dialysis Patients","volume":"3","author":"Schurig","year":"1979","journal-title":"Artif. Organs"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1161\/01.HYP.19.6.508","article-title":"Orthostatic hypotension in older adults. The Cardiovascular Health Study. CHS Collaborative Research Group","volume":"19","author":"Rutan","year":"1992","journal-title":"Hypertension"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.kint.2020.11.003","article-title":"KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease","volume":"99","author":"Cheung","year":"2021","journal-title":"Kidney Int."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1161\/HYPERTENSIONAHA.110.151654","article-title":"Orthostatic hypotension is a more robust predictor of cardiovascular events than nighttime reverse dipping in elderly","volume":"56","author":"Fagard","year":"2010","journal-title":"Hypertension"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1111\/joim.12249","article-title":"Physical countermeasures to increase orthostatic tolerance","volume":"277","author":"Wieling","year":"2015","journal-title":"J. Intern. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/14\/3075\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:29:12Z","timestamp":1760164152000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/14\/3075"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,12]]},"references-count":52,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2021,7]]}},"alternative-id":["jcm10143075"],"URL":"https:\/\/doi.org\/10.3390\/jcm10143075","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,12]]}}}