Key result
In adults with hypertensive crisis, comorbid CKD and ESRD were associated with higher rates of hospital admission (78.3% and 72.6% vs 44.7%; P<0.0001) and mortality compared to no renal dysfunction.
Why the study?
The epidemiology and outcomes of hypertensive crisis in patients with chronic kidney disease and end-stage renal disease have not been well studied.
What are the incidence and outcomes of hypertensive crisis in patients with CKD and ESRD compared to those without renal dysfunction?
Observational (n=680,333)
Yes
What are the incidence and outcomes of hypertensive crisis in patients with CKD and ESRD compared to those without renal dysfunction?
Absolute Event Rate: 78.3% vs 44.7%
p-value: p=<0.0001
Hypertensive crisis in patients with CKD and ESRD is associated with significantly higher rates of hypertensive emergencies, hospital admissions, in-hospital mortality, and healthcare costs compared to patients without renal dysfunction.
BACKGROUND: The epidemiology and outcomes of hypertensive crisis (HTN-C) in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) have not been well studied. The objective of our study is to describe the incidence, clinical characteristics, and outcomes of emergency department (ED) visits for HTN-C in patients with CKD and ESRD. METHODS: We performed a secondary analysis of Nationwide Emergency Department Sample databases for years 2016-2018 by identifying adult patients presenting to ED with hypertension related conditions as primary diagnosis using appropriate diagnosis codes. RESULTS: There were 348 million adult ED visits during the study period. Of these, 680 333 (0.2%) ED visits were for HTN-C. Out of these, majority were in patients without renal dysfunction (82%), with 11.4 and 6.6% were in patients with CKD and ESRD, respectively. The CKD and ESRD groups had significantly higher percentages of hypertensive emergency (HTN-E) presentation than in the No-CKD group (38.9, 34.2 and 22.4%, respectively; P < 0.001). ED visits for HTN-C frequently resulted in hospital admission and these were significantly higher in patients with CKD and ESRD than in No-CKD (78.3 vs. 72.6 vs. 44.7%; P < 0.0001). In-hospital mortality was overall low but was higher in CKD and ESRD than in No-CKD group (0.3 vs. 0.2 vs. 0.1%; P < 0.0001), as was cost of care (USD 28 534, USD 29 465 and USD 26 394, respectively; P < 0.001). CONCLUSION: HTN-C constitutes a significant burden on patients with CKD and ESRD compared with those without CKD with a higher proportion of ED visits, incidence of HTN-E, hospitalization rate, in-hospital mortality and cost of care. http://links.lww.com/HJH/C22.
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Pothuru et al. (2022) conducted an observational in Hypertensive crisis in patients with chronic kidney disease and end-stage renal disease (n=680,333). Chronic kidney disease (CKD) and end-stage renal disease (ESRD) vs. No renal dysfunction (No-CKD) was evaluated on Hospital admission (p=<0.0001). In adults with hypertensive crisis, comorbid CKD and ESRD were associated with higher rates of hospital admission (78.3% and 72.6% vs 44.7%; P<0.0001) and mortality compared to no renal dysfunction.
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