title: Elevated BP after AKI.
abstract: The connection between AKI and BP elevation is unclear. We conducted a retrospective cohort study to evaluate whether AKI in the hospital is independently associated with BP elevation during the first 2 years after discharge among previously normotensive adults. We studied adult members of Kaiser Permanente Northern California, a large integrated health care delivery system, who were hospitalized between 2008 and 2011, had available preadmission serum creatinine and BP measures, and were not known to be hypertensive or have BP>140/90 mmHg. Among 43,611 eligible patients, 2451 experienced AKI defined using observed changes in serum creatinine concentration measured during hospitalization. Survivors of AKI were more likely than those without AKI to have elevated BP--defined as documented BP>140/90 mmHg measured during an ambulatory, nonemergency department visit--during follow-up (46.1% versus 41.2% at 730 days; P<0.001). This difference was evident within the first 180 days (30.6% versus 23.1%; P<0.001). In multivariable models, AKI was independently associated with a 22% (95% confidence interval, 12% to 33%) increase in the odds of developing elevated BP during follow-up, with higher adjusted odds with more severe AKI. Results were similar in sensitivity analyses when elevated BP was defined as having at least two BP readings of >140/90 mmHg or those with evidence of CKD were excluded. We conclude that AKI is an independent risk factor for subsequent development of elevated BP. Preventing AKI during a hospitalization may have clinical and public health benefits beyond the immediate hospitalization.
authors.affiliation: Departments of Medicine and Division of Research, Kaiser Permanente Northern California, Oakland, California; hsuchi@medicine.ucsf.edu.
authors.forename: Chi-yuan
authors.initials: CY
authors.lastname: Hsu
authors.affiliation: Departments of Medicine and.
authors.forename: Raymond K
authors.initials: RK
authors.lastname: Hsu
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California;
authors.forename: Jingrong
authors.initials: J
authors.lastname: Yang
authors.affiliation: Division of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, California; and.
authors.forename: Juan D
authors.initials: JD
authors.lastname: Ordonez
authors.affiliation: Division of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, California; and.
authors.forename: Sijie
authors.initials: S
authors.lastname: Zheng
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California;
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002140:California / Q000453:epidemiology; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D015994:Incidence; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
keywords: BP; acute renal failure; hypertension; risk factors