BURDEN AND OUTCOMES OF CKD IN PATIENTS PRESENTING WITH HYPERTENSIVE CRISIS

Introduction:

Hypertension and chronic kidney disease (CKD) are closely interlinked pathophysiologically. Sustained hypertension can lead to worsening kidney function and progressive decline in kidney function can lead to worsening blood pressure control. The prevalence of CKD in patients presenting with hypertensive crisis is purported to be high but has not been previously quantified in developing countries such as India, where the burden of CKD is already known. In addition, little is known about the association of chronic kidney dysfunction and their outcomes in hypertensive crisis.

Methods:

AIMS AND OBJECTIVES

Primary objective: To estimate the prevalence of chronic kidney disease in patients presenting with hypertensive crisis

Secondary objective: To determine the association between the presence of CKD and outcomes of patients presenting with hypertensive crisis

Study design: Prospective observational study

Inclusion criteria:

1. Patients 18 years and older

2. Blood pressure at presentation ≥ 180/120mm Hg

Exclusion criteria:

1.    Head trauma

2.    Pregnant women

Sampling: Consecutive sampling

Sample size calculation: Assuming a prevalence of 80% and a precision of 5% to achieve a power of 80% with an attrition rate of 10% during follow up, a sample size of 270 was calculated.

                (0.80x0.20x1.962/0.052 + 10% = 269)

Study procedure: After obtaining approval of IRC/IEC, the study was performed for a period of 18 months. Subjects were screened at the EMS for an admitting diagnosis of hypertensive crisis (>180/>120 mmHg). Patient demographics, history, examination findings and investigations were noted. Patients were seen in the EMS during their first visit and were followed through discharge from the hospital and after one month. Those who had not followed up were contacted over phone. Results were analyzed using appropriate statistical tests.

Results:

The prevalence of chronic kidney disease presenting with hypertensive crisis was 48% in our study. In nearly half the cases, the etiology of CKD was unknown. Half of the population with CKD were in CKD-EPI stage 5 (End stage renal disease). Mortality during hospital stay was significantly higher in the non-CKD group when compared to the CKD group. However, the same was not reflected at one month following discharge.

Conclusions:

Our study highlights the disproportionate prevalence of patients with CKD presenting with hypertensive crises, and acute worsening with ACS and or AKI, all of which are eminently treatable and preventable. Despite good compliance and initiation of MHD, this subset of patients continued to have less than optimal control of BP thereby revealing the need for more frequent follow up visits and or more dialyses. Also, better community level support in the form of dialysis centres with nephrologists might be required for timely assessment of the CKD population which can avoid the burgeoning load of patients reaching emergency departments.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.