Hypertensive crisis leads to worse outcomes in CKD, ESRD patients

Hypertensive crisis (HTN-C) is a major burden on patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) relative to those without, reveals a study. HTN-C usually results in a higher number of emergency department visits, incidence of hypertensive emergency, hospitalization rate, in-hospital mortality, and cost of care.

In this study, the authors conducted a secondary analysis of Nationwide Emergency Department Sample databases for years 2016‒2018 by identifying adult patients presenting to the ED with hypertension-related conditions as primary diagnosis using appropriate diagnosis codes.

A total of 348 million adult ED visits were recorded during the study period, of which 680,333 (0.2 percent) were for HTN-C. Most of these patients had no renal dysfunction (82 percent), while 11.4 percent and 6.6 percent had CKD and ESRD, respectively.

Patients in the CKD and ESRD groups had markedly higher percentages of hypertensive emergency presentation than those in the no-CKD group (38.9 percent and 34.2 percent vs 22.4 percent; p<0.001).

ED visits for HTN-C normally led to hospital admission, which were significantly greater in patients with CKD and ESRD than those without CKD (78.3 percent and 72.6 percent vs 44.7 percent; p<0.0001).

Overall, in-hospital mortality was low, but it was higher in CKD and ESRD groups than in the no-CKD group (0.3 percent and 0.2 percent vs 0.1 percent). Cost of care was also higher in the former groups than in the latter (USD 28,534 and 29,465 vs 26,394; p<0.001).