Risk of Orthostatic Hypotension in Chronic Kidney Disease: A Community-Based Cohort Study

Introduction: Patients with chronic kidney disease (CKD) often experience symptoms consistent with orthostatic hypotension (OH); however, not much is known about OH in this population. Therefore, study analyzed OH prevalence and risk according to renal function decline. Methods: A community-based cohort study was conducted using data from the Korean Genome and Epidemiology Study (KoGES). OH prevalence was assessed at baseline and at a 2-year follow-up across three estimated glomerular filtration rate (eGFR) categories: high (≥90 mL/min/1.73m², G1), moderate (60–89 mL/min/1.73m², G2), and low (<60 mL/min/1.73m², G3). Results: Among 9 597 participants, baseline OH, 2-year OH, and persistent OH were evaluated within each eGFR group: high (n=6 743), moderate (n=2 758), and low (n=96). The low eGFR group demonstrated the highest prevalence of baseline OH (n=52, p=0.024) and 2-year OH (n=42, p=0.002). This group also exhibited the largest decline in systolic blood pressure at both baseline and follow-up. In adjusted logistic regression, participants aged <50 years with low eGFR had 3.54-fold higher odds of OH (p=0.035). Additionally, adherence to a low-sodium diet was associated with increased 2-year OH prevalence across groups (p=0.001). Conclusion: The low eGFR group showed a higher baseline and follow-up OH prevalence. A low-sodium diet was also associated with elevated OH risk, underscoring the need for careful dietary management in patients with CKD.