Document Detail


Acute kidney injury and cardiovascular outcomes in acute severe hypertension.
MedLine Citation:
PMID:  20458014     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
METHODS AND 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.
Authors:
Lynda A Szczech; Christopher B Granger; Joseph F Dasta; Alpesh Amin; W Frank Peacock; Peter A McCullough; John W Devlin; Matthew R Weir; Jason N Katz; Frederick A Anderson; Allison Wyman; Joseph Varon;
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-05-10
Journal Detail:
Title:  Circulation     Volume:  121     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-25     Completed Date:  2010-06-17     Revised Date:  2011-04-18    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2183-91     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, Division of Nephrology, Duke University Medical Center, Box 3646, Durham, NC 27710, USA. szcze001@mc.duke.edu
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged
Antihypertensive Agents / therapeutic use
Cardiovascular System / physiopathology*
Chronic Disease
Cohort Studies
Comorbidity
Female
Glomerular Filtration Rate
Hospitalization
Humans
Hypertension / drug therapy,  epidemiology*,  physiopathology*
Kidney Diseases / epidemiology*,  mortality,  therapy
Male
Middle Aged
Morbidity
Risk Assessment
Severity of Illness Index
Chemical
Reg. No./Substance:
0/Antihypertensive Agents
Investigator
Investigator/Affiliation:
Alpesh Amin / ; Joseph F Dasta / ; James Ferguson / ; Joel Gore / ; Christopher B Granger / ; Kurt Kleinschmidt / ; Stephan A Mayer / ; Alan S Multz / ; W Frank Peacock / ; Eric Peterson / ; Charles Pollack / ; Andrew F Shorr / ; Gene Yong Sung / ; Joseph Varon / ; Matthew Weir / ; John Cienki / ; Lala Dunbar / ; John Devlin / ; Deborah Diercks / ; Icilma Fergus / ; James Froehlich / ; Tony Gerlach / ; Marc LaPointe / ; Phillip Levy / ; Chadwick Miller / ; Richard Nowak / ; Brian O'Neil / ; Noleen Ostapkovich / ; Namrata Patil / ; Jon Schrock / ; Adam Singer / ; Brian Tiffnay / ; Joseph Varon /
Comments/Corrections
Comment In:
Nat Rev Nephrol. 2010 Jul;6(7):384   [PMID:  20597157 ]
Circulation. 2011 Mar 8;123(9):e267; author reply e268   [PMID:  21382901 ]
Circulation. 2010 May 25;121(20):2160-1   [PMID:  20458007 ]
Nat Rev Cardiol. 2010 Aug;7(8):417   [PMID:  20681051 ]

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