Chronic Episodic Hypotension as a Cause of Chronic Kidney Disease

Chronic kidney disease (CKD) is a global health concern characterized by the gradual loss of renal function as seen by the decline of the estimated glomerular filtration rate (eGFR). While hypertension is a well-documented risk factor for CKD progression, the influence of hypotension on this condition remains less explored. Hypotension is an independent predictor of CKD progression. Patients experiencing hypotension show a significantly faster and steadier decline in the eGFR when compared to the normotensive CKD patients. Notably, the use of antihypertensive medication and diuretics is associated with a higher likelihood of hypotension. We have seen several cases where tapering down or completely stopping antihypertensive medications, as well as treating orthostatic hypotension, has resulted in improved CKD and renal function. These findings highlight the importance of monitoring blood pressure levels in CKD patients, as hypotension may contribute to an accelerated decline in renal function and increased morbidity. These case studies aim to investigate the sustained improvement of the eGFR from avoiding chronic episodic hypotension by adjusting blood pressure medications for a duration of 2-5 years.