IMPACT OF THE ESTIMATED GLOMERULAR FILTRATION RATE ON LONG-TERM MORTALITY IN PATIENTS WITH HYPERTENSIVE CRISIS VISITING THE EMERGENCY DEPARTMENT

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Objective: The association between renal function and all-cause mortality among patients with hypertensive crisis is unclear. We aimed to identify the impact of the estimated glomerular filtration rate (eGFR) on all-cause mortality in patients with hypertensive crisis visiting the emergency department (ED). Design and method: 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 m2. Results: Among the 4,821 patients, 46.7% and 5.8% had an eGFR of > = 90 and < 30 mL/min/1.73 m2, respectively. The patients with a lower eGFR were older and more likely to have comorbidities. The 3-year all-cause mortality was 7.7% and 41.9% in those with an eGFR of > = 90 and < 30 mL/min/1.73 m2, respectively. After adjustments for confounding variables, those with an eGFR of 30–59 (hazard ratio [HR], 2.00; 95% confidence interval [CI], 1.53–2.62) and < 30 mL/min/1.73 m2 (HR, 2.45; 95% CI, 1.79–3.37) had significantly higher 3-year all-cause mortality risks than those with an eGFR of > = 90 mL/min/1.73 m2. The patients with an eGFR of 60–89 mL/min/1.73 m2 had a higher mortality (21.1%) than those with an eGFR of > = 90 mL/min/1.73 m2 (7.7%); however, the difference was not significant (HR, 1.23; 95% CI, 0.96–1.58). Conclusions: Renal impairment is common in patients with hypertensive crisis visiting the ED. There is a strong independent association between decreased eGFR and all-cause mortality in these patients. The eGFR provides useful prognostic information and permits 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 visiting the ED.