{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:04:25Z","timestamp":1789736665445,"version":"4.0.1"},"reference-count":38,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2019,4,20]],"date-time":"2019-04-20T00:00:00Z","timestamp":1555718400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objective: Orthostatic hypotension (OH) is a decrease in systolic blood pressure (BP) of 20 mm Hg and in diastolic BP of 10 mm Hg when changing the position from lying to standing. Arterial hypertension (AH), comorbidities and polypharmacy contribute to its development. The aim was to assess the presence of OH and its predictors in asymptomatic chronic kidney disease (CKD) patients. Material and methods: 45 CKD patients with estimated glomerular filtration rate (eGFR) \u2264 60 mL\/min\/1.73 m2 (CKD+) were examined for signs of OH and its predictors. The results were compared with the control group of 22 patients with eGFR &gt; 60 mL\/min\/1.73 m2 (CKD\u2013). Asymptomatic patients without ischemic heart disease and previous stroke were qualified. Total blood count, serum creatinine, eGFR, urea, phosphates, calcium, albumins, parathyroid hormone, uric acid, C reactive protein, N-terminal pro b-type natriuretic peptide, lipid profile, and urine protein to creatinine ratio were assessed. Simultaneously, patients underwent echocardiography. To detect OH, a modified Schellong test was performed. Results: OH was diagnosed in 17 out of 45 CKD+ patients (average age 69.12 \u00b1 13.2) and in 8 out of 22 CKD\u2013 patients (average age 60.50 \u00b1 14.99). The CKD+ group demonstrated significant differences on average values of systolic and diastolic BP between OH+ and OH\u2013 patients, lower when standing. In the eGFR range of 30\u201360 mL\/min\/1.73 m2 correlation was revealed between OH and \u03b2-blockers (p = 0.04), in the entire CKD+ group between \u03b2-blockers combined with diuretics (p = 0.007) and ACE-I (p = 0.033). Logistic regression test revealed that chronic heart failure (CHF, OR = 15.31), treatment with \u03b2-blockers (OR = 13.86) were significant factors influencing the presence of OH. Conclusions: Predictors of OH in CKD may include: CHF, treatment with \u03b2-blockers, combined with ACE-I and diuretics.<\/jats:p>","DOI":"10.3390\/medicina55040113","type":"journal-article","created":{"date-parts":[[2019,4,22]],"date-time":"2019-04-22T11:02:53Z","timestamp":1555930973000},"page":"113","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Orthostatic Hypotension in Asymptomatic Patients with Chronic Kidney Disease"],"prefix":"10.3390","volume":"55","author":[{"given":"Beata","family":"Januszko-Giergielewicz","sequence":"first","affiliation":[{"name":"Family Medicine Unit, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, ul. Warszawska 30, 10-082 Olsztyn, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8827-4203","authenticated-orcid":false,"given":"Leszek","family":"Gromadzi\u0144ski","sequence":"additional","affiliation":[{"name":"II Clinical Department of Cardiology and Internal Medicine, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, ul. Warszawska 30, 10-082 Olsztyn, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Dudziak","sequence":"additional","affiliation":[{"name":"Cardiac Diagnostic Unit, II Department of Cardiology, Medical University of Gda\u0144sk, ul. Mariana Smoluchowskiego 17, 80-214 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8210-8063","authenticated-orcid":false,"given":"Alicja","family":"D\u0119bska-\u015alizie\u0144","sequence":"additional","affiliation":[{"name":"Clinical Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gda\u0144sk, ul. D\u0119binki 7, 80-211 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,4,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"The consensus committee of the American Autonomic Society and the American Academy of Neurology (1996). Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology, 46, 1470.","DOI":"10.1212\/WNL.46.5.1470"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2942","DOI":"10.2337\/diacare.27.12.2942","article-title":"Autonomic symptoms and diabetic neuropathy: A population-based study","volume":"27","author":"Low","year":"2004","journal-title":"Diabetes Care"},{"key":"ref_3","first-page":"e3166","article-title":"Management of orthostatic hypotension: A literature review","volume":"10","author":"Ali","year":"2018","journal-title":"Cureus"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/0895-7061(95)00348-7","article-title":"Changes in frequency of orthostatic hypotension in elderly hypertensive patients under medications","volume":"9","author":"Masuo","year":"1996","journal-title":"Am. J. Hypertens."},{"key":"ref_5","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_6","first-page":"157","article-title":"Cardiovascular autonomic neuropathy","volume":"29","author":"McCarty","year":"2016","journal-title":"Proc. (Bayl. Univ. Med. Cent.)"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1002\/mus.20713","article-title":"Uremic neuropathy: Clinical features and new pathophysiological insights","volume":"35","author":"Krishnan","year":"2007","journal-title":"Muscle Nerve"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.ancard.2014.05.013","article-title":"Orthostatic hypotension is associated with more severe hypertension in elderly autonomous diabetic patients from the French Gerodiab study at inclusion","volume":"63","author":"Bouhanick","year":"2014","journal-title":"Ann. Cardiol. Angeiol. (Paris)"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.jdiacomp.2015.08.020","article-title":"Ortostatic hypotension in diabetic patients-10-year follow-up study","volume":"30","author":"Gaspar","year":"2016","journal-title":"J. Diabetes Complicat."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1136\/thx.50.7.793","article-title":"Phrenic neuropathy in chronic renal failure","volume":"50","author":"Zifko","year":"1995","journal-title":"Thorax"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1111\/sdi.12093","article-title":"Sympathetic nervous system function and dysfunction in chronic hemodialysis patients","volume":"26","author":"Rubinger","year":"2013","journal-title":"Semin. Dial."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.transproceed.2014.11.034","article-title":"Dobutamine stress echocardiography in the diagnosis of asymptomatic ischemic heart disease in patients with chronic kidney disease-review of literature and single-center experience","volume":"47","author":"Kozak","year":"2015","journal-title":"Transplant. Proc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1016\/j.clinph.2006.02.002","article-title":"Neuropathy, axonal Na+\/K+ pump function and activity-dependent excitability changes in end-stage kidney disease","volume":"117","author":"Krishnan","year":"2006","journal-title":"Clin. Neurophysiol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Tamul\u0117nait\u0117, E., \u017dvirblyt\u0117, R., Ereminien\u0117, R., \u017diginskien\u0117, E., and Ereminien\u0117, E. (2018). Changes of left and right ventricle mechanics and function in patients with end-stage renal disease undergoing haemodialysis. Medicina (Kaunas), 54.","DOI":"10.3390\/medicina54050087"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1038\/ajh.2012.31","article-title":"Association of heart failure hospitalizations with combined electrocardiography and echocardiography criteria for left ventricular hypertrophy","volume":"25","author":"Gerdts","year":"2012","journal-title":"Am. J. Hypertens."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1159\/000369106","article-title":"Echocardiographic changes in patients with stage 3-5 chronic kidney disease and left ventricular diastolic dysfunction","volume":"4","author":"Pruszczyk","year":"2014","journal-title":"Cardiorenal Med."},{"key":"ref_17","first-page":"107","article-title":"Recommendations for the evaluation of left ventricular diastolic function by echocardiography","volume":"22","author":"Nagueh","year":"2009","journal-title":"Eur. J. Echocardiogr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1093\/ndt\/17.6.1085","article-title":"Quantifying comorbidity in peritoneal dialysis patients and its relationship to other predictors of survival","volume":"17","author":"Davies","year":"2002","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1161\/CIRCULATIONAHA.106.634949","article-title":"Diabetic cardiovascular autonomic neuropathy","volume":"115","author":"Vinik","year":"2007","journal-title":"Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"334","DOI":"10.2337\/diacare.29.02.06.dc05-1242","article-title":"Cardiac autonomic neuropathy predicts cardiovascular morbidity and mortality in type 1 diabetic patients with diabetic nephropathy","volume":"29","author":"Astrup","year":"2006","journal-title":"Diabetes Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1161\/01.CIR.100.8.813","article-title":"Effects of autonomic neuropathy on coronary blood flow in patients with diabetes mellitus","volume":"100","author":"Landa","year":"1999","journal-title":"Circulation"},{"key":"ref_22","first-page":"149","article-title":"Przydatno\u015b\u0107 monitorowania EKG metod\u0105 Holtera do oceny ryzyka pacjent\u00f3w z chorobami uk\u0142adu kr\u0105\u017cenia [Usefulness of Holter monitoring for risk assessment in patients with cardiovacular diseases]","volume":"2","author":"Kurpesa","year":"2005","journal-title":"Choroby Serca Naczy\u0144"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1046\/j.1523-1755.2001.0590031175.x","article-title":"Preventing dialysis hypotension: A comparison of usual protective maneuvers","volume":"59","author":"Dheenan","year":"2001","journal-title":"Kidney Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.1093\/ndt\/gfi056","article-title":"Measurement of relative blood volume changes during haemodialysis: Merits and limitations","volume":"20","author":"Dasselaar","year":"2005","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1056\/NEJM199602293340907","article-title":"Adrenergic receptors\u2014Evolving concepts and clinical implications","volume":"334","author":"Insel","year":"1996","journal-title":"N. Engl. J. Med."},{"key":"ref_26","first-page":"271","article-title":"Autonomiczny uk\u0142ad nerwowy a nadci\u015bnienie t\u0119tnicze i nerki [Autonomic nervous system and hypertension and kidney]","volume":"3","author":"Polak","year":"1999","journal-title":"Nefrol. Dial. Pol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.1097\/00004872-199816121-00019","article-title":"Role of the sympathetic nervous system in human hypertension","volume":"16","author":"Grassi","year":"1998","journal-title":"J. Hypertens."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/00005344-200000004-00001","article-title":"Sympathetic nervous system activation in essential hypertension, cardiac failure and psychosomatic heart disease","volume":"35","author":"Esler","year":"2000","journal-title":"J. Cardiovasc. Pharmacol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1253\/circj.67.601","article-title":"Heart rate turbulence and clinical prognosis in hypertrophic cardiomyopathy and myocardial infarction","volume":"67","author":"Kawasaki","year":"2003","journal-title":"Circ. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1253\/circj.66.902","article-title":"Evaluation of heart-rate turbulence as a new prognostic marker in patients with chronic heart failure","volume":"66","author":"Koyama","year":"2002","journal-title":"Circ. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1097\/00000542-198602000-00032","article-title":"Autonomic neuropathy in a diabetic patient with renal failure","volume":"64","author":"Ciccarelli","year":"1986","journal-title":"Anesthesiology"},{"key":"ref_32","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_33","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1111\/j.1532-5415.2008.01946.x","article-title":"Orthostatic hypotension and risk of cardiovascular disease in elderly people: The Rotterdam study","volume":"56","author":"Verwoert","year":"2008","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1093\/ndt\/16.suppl_1.67","article-title":"Sympathetic overactivity and arterial hypertension in renal failure","volume":"16","author":"Orth","year":"2001","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Hamrefors, V., H\u00e4rstedt, M., Holmberg, A., Rogmark, C., Sutton, R., Melander, O., and Fedorowski, A. (2016). Orthostatic hypotension and elevated resting heart rate predict low-energy fractures in the population: The Malm\u00f6 Preventive Project. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0154249"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1161\/HYPERTENSIONAHA.118.11337","article-title":"Hypertension treatment effects on orthostatic hypotension and its relationship with cardiovascular disease","volume":"72","author":"Juraschek","year":"2018","journal-title":"Hypertension"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Petkovi\u0107, N., Risti\u0107, S., Marinkovi\u0107, J., Mari\u0107, R., Kova\u010devi\u0107, M., and Djukanovi\u0107, L. (2018). Differences in risk factors and prevalence of vascular calcification between pre-dialysis and hemodialysis balkan nephropathy patients. Medicina (Kaunas), 54.","DOI":"10.3390\/medicina54010004"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/j.jash.2016.08.005","article-title":"Orthostatic changes in systolic blood pressure among SPRINT participants at baseline","volume":"10","author":"Townsend","year":"2016","journal-title":"J. Am. Soc. Hypertens."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/4\/113\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:46:55Z","timestamp":1760186815000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/4\/113"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,20]]},"references-count":38,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019,4]]}},"alternative-id":["medicina55040113"],"URL":"https:\/\/doi.org\/10.3390\/medicina55040113","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,20]]}}}