Burden and outcomes of chronic kidney disease in patients presenting with hypertensive crisis

Abstract

Abstract Objectives To determine prevalence of chronic kidney disease (CKD) in patients presenting with hypertensive crises and to determine their 30-day outcomes with respect to blood pressure (BP), creatinine level, and mortality. Methods Patients admitted to the HTN-C were prospectively enrolled. Demographics, examinations, target organ damage (TOD), and investigations were recorded. Patients were classified as hypertensive emergency(HTN-E) or hypertensive urgent(HTN-U). TODs included cardiovascular (acute coronary syndromes and pulmonary edema), neurological (stroke, encephalopathy), ocular (retinal hemorrhage, papilledema), renal (acute kidney injury-AKI), and hematological (microangiopathic hemolytic anemia). The CKD burden was determined. BP, creatinine, and mortality were assessed at discharge and after 30 days. AKI was confirmed at follow-up, with a reduction in creatinine level of > 25%. Results 235/262 patients had HTN-E; patients were mostly male and middle-aged. The TOD with decreasing frequency was cardiovascular(53%), ocular(29%), neurological(26%), and AKI(24%). Patients with CKD were significantly younger, had hypertension with ≥ 2 drugs, and had a higher proportion of TOD. Patients with CKD had significantly higher BP and creatinine levels at discharge and at 30 days; the non-CKD group had a higher inpatient mortality rate and lower mortality at 30 days. Conclusions Specific markers of AKI in patients with underlying CKD are needed to prioritize care during hypertensive crises. Better community-level support in the form of physicians, nephrologists, and dialysis centers is required for timely assessment of the diagnosis and progression of CKD, recognition and treatment of AKI, control of blood pressure, and regular dialysis, which may reduce the load on emergency departments for hypertensive crises.