Burden and 30-day Outcomes of Chronic Kidney Disease in Patients Presenting with Hypertensive Crisis

Background: Studies on the prevalence of chronic kidney disease (CKD) in patients presenting with hypertensive crises are scarce. This study aimed to determine the prevalence of CKD in patients presenting with hypertensive crises (HTN-C) and their 30-day outcomes concerning blood pressure, creatinine level, and mortality.

Methods: Patients admitted with HTN-C were prospectively enrolled. Demographics, examinations, target organ damage (TOD), and investigations were recorded. Patients were classified as having a hypertensive emergency (HTN-E) or hypertensive urgency (HTN-U). Target organ damages included cardiovascular (acute coronary syndromes and pulmonary edema), neurological (stroke and encephalopathy), ocular (retinal hemorrhage and papilledema), renal (acute kidney injury (AKI)), and hematological (microangiopathic hemolytic anemia). The CKD burden was also determined. Blood pressure (BP), creatinine, and mortality were assessed at discharge and a"er 30 days. Acute kidney injury on CKD was confirmed at follow-up with a change in creatinine from the baseline of #25%.

Results: Out of 262 patients, 235 had HTN-E; patients were mostly males. Target organ damages, in decreasing frequency, were cardiovascular (53%), ocular (29%), neurological (26%), and AKI (24%). Patients with CKD were significantly younger, had hypertension treated with #2 drugs, and had a higher proportion of TOD. Patients with CKD had significantly higher BP and creatinine levels at discharge and at 30 days. The non-CKD group had a higher inpatient mortality rate and a lower mortality rate at 30 days.

Conclusion: Better community-level support is required for timely assessment of the diagnosis and progression of CKD, recognition and treatment of AKI, BP control, and regular kidney replacement therapy, which may reduce the load on emergency departments.

Cite this article as: Mohan Yalavarthy Y, Viswanathan S, Selvaraj J. Burden and 30-day outcomes of chronic kidney disease in patients presenting with hypertensive crisis. Turk J Nephrol. 2025;34(1):27-36.