Impact of the estimated glomerular filtration rate on long-term mortality in patients with hypertensive crisis visiting the emergency department

Background The association between renal function and all-cause mortality in patients with hypertensive crisis remains unclear. We aimed to identify the impact of estimated glomerular filtration rate (eGFR) on all-cause mortality in patients with hypertensive crisis visiting the emergency department (ED). Methods This retrospective study included patients aged >= 18 years admitted to the ED between 2016 and 2019 for hypertensive crisis (systolic blood pressure >= 180 mmHg and/or diastolic blood pressure >= 110 mmHg). They were classified into four groups according to the eGFR at admission to the ED: >= 90, 60-89, 30-59, and <30 mL/min/1.73 m(2). Results Among the 4,821 patients, 46.7% and 5.8% had an eGFR of >= 90 and <30 mL/min/1.73 m(2), respectively. Patients with lower eGFR were older and more likely to have comorbidities. The 3-year all-cause mortality rates were 7.7% and 41.9% in those with an eGFR >= 90 and <30 mL/min/1.73 m(2), respectively. After adjusting for confounding variables, those with an eGFR of 30-59 (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.47-2.54) and <30 mL/min/1.73 m(2) (HR, 2.35; 95% CI, 1.71-3.24) had significantly higher 3-year all-cause mortality risks than those with an eGFR of >= 90 mL/min/1.73 m(2). Patients with an eGFR of 60-89 mL/min/1.73 m(2) had a higher mortality (21.1%) than those with an eGFR of >= 90 mL/min/1.73 m(2) (7.7%); however, the difference was not significant (HR, 1.21; 95% CI, 0.94-1.56). Conclusions Renal impairment is common in patients with hypertensive crisis who visit the ED. A strong independent association was observed between decreased eGFR and all-cause mortality in these patients. eGFR provides useful prognostic information and permits the early identification of patients with hypertensive crisis with an increased mortality risk. Intensive treatment and follow-up strategies are needed for patients with a decreased eGFR who visit the ED.

Automated summary

This study aimed to identify the impact of estimated glomerular filtration rate (eGFR) on all-cause mortality in patients with hypertensive crisis. The results showed a significant association between renal function impairment and all-cause mortality in patients with hypertensive crisis. Specifically, patients with eGFR ranging from 30-59 mL/min/1.73 m(2) and <30 mL/min/1.73 m(2) had a significantly higher 3-year all-cause mortality risk. Therefore, intensive treatment and follow-up strategies are needed for hypertensive crisis patients with decreased eGFR visiting the emergency department.