Acute kidney injury and cardiovascular outcomes in acute severe hypertension.
BACKGROUND
Little is known about the association of kidney dysfunction and outcome in acute severe hypertension. This study aimed to measure the association between baseline chronic kidney disease (estimated glomerular filtration rate), acute kidney injury (AKI, decrease in estimated glomerular filtration rate > or =25% from baseline) and outcome in patients hospitalized with acute severe hypertension.


RESULTS
The Studying the Treatment of Acute Hypertension (STAT) registry enrolled patients with acute severe hypertension, defined as > or =1 blood pressure measurement >180 mm Hg systolic and/or >110 mm Hg diastolic and treated with intravenous antihypertensive therapy. Data were compared across groups categorized by admission estimated glomerular filtration rate and AKI during admission. On admission, 79% of the cohort (n=1566) had at least mild chronic kidney disease (estimated glomerular filtration rate <60 mL/min in 46%, <30 mL/min in 22%). Chronic kidney disease patients were more likely to develop heart failure (P<0.0001), non-ST-elevation myocardial infarction (P=0.003), and AKI (P<0.007). AKI patients were at greater risk of heart failure and cardiac arrest (P< or =0.0001 for both). Subjects with AKI experienced higher mortality at 90 days (P=0.003). Any acute loss of estimated glomerular filtration rate during hospitalization was independently associated with an increased risk of death (odds ratio, 1.05; P=0.03 per 10-mL/min decline). Other independent predictors of mortality included increasing age (P<0.0001), male gender (P=0.016), white versus black race (P=0.003), and worse baseline kidney function (P=0.003).


CONCLUSIONS
Chronic kidney disease is a common comorbidity among patients admitted with acute severe hypertension, and AKI is a frequent form of acute target organ dysfunction, particularly in those with baseline chronic kidney disease. Any degree of AKI is associated with a greater risk of morbidity and mortality.
Szczech
Lynda A
LA
Department of Medicine, Division of Nephrology, Duke University Medical Center, Box 3646, Durham, NC 27710, USA. szcze001@mc.duke.edu
Granger
Christopher B
CB
Dasta
Joseph F
JF
Amin
Alpesh
A
Peacock
W Frank
WF
McCullough
Peter A
PA
Devlin
John W
JW
Weir
Matthew R
MR
Katz
Jason N
JN
Anderson
Frederick A
FA
Wyman
Allison
A
Varon
Joseph
J
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002319:Cardiovascular System / Q000503:physiopathology*; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology*; D007674:Kidney Diseases / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D018570:Risk Assessment; D012720:Severity of Illness Index
D000959:Antihypertensive Agents