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. 2016 Mar;27(3):914-23.
doi: 10.1681/ASN.2014111114. Epub 2015 Jul 1.

Elevated BP after AKI

Chi-yuan Hsu  1 , Raymond K Hsu  2 , Jingrong Yang  3 , Juan D Ordonez  4 , Sijie Zheng  4 , Alan S Go  5
Affiliations

Elevated BP after AKI

Chi-yuan Hsu et al. J Am Soc Nephrol. 2016 Mar.

Abstract

The connection between AKI and BP elevation is unclear. We conducted a retrospective cohort study to evaluate whether AKI in the hospital is independently associated with BP elevation during the first 2 years after discharge among previously normotensive adults. We studied adult members of Kaiser Permanente Northern California, a large integrated health care delivery system, who were hospitalized between 2008 and 2011, had available preadmission serum creatinine and BP measures, and were not known to be hypertensive or have BP>140/90 mmHg. Among 43,611 eligible patients, 2451 experienced AKI defined using observed changes in serum creatinine concentration measured during hospitalization. Survivors of AKI were more likely than those without AKI to have elevated BP--defined as documented BP>140/90 mmHg measured during an ambulatory, nonemergency department visit--during follow-up (46.1% versus 41.2% at 730 days; P<0.001). This difference was evident within the first 180 days (30.6% versus 23.1%; P<0.001). In multivariable models, AKI was independently associated with a 22% (95% confidence interval, 12% to 33%) increase in the odds of developing elevated BP during follow-up, with higher adjusted odds with more severe AKI. Results were similar in sensitivity analyses when elevated BP was defined as having at least two BP readings of >140/90 mmHg or those with evidence of CKD were excluded. We conclude that AKI is an independent risk factor for subsequent development of elevated BP. Preventing AKI during a hospitalization may have clinical and public health benefits beyond the immediate hospitalization.

Keywords: BP; acute renal failure; hypertension; risk factors.

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Figures

Figure 1.
Figure 1.
Assembly of an analytic cohort of patients who were hospitalized between January 1, 2008, and December 31, 2011. After applying a series of exclusion criteria which are not mutually exclusive, 43,611 unique patients were identified for our main analysis. BMI, body mass index; DBP, diastolic BP; SBP, systolic BP.
Figure 2.
Figure 2.
Cumulative incidence of elevated BP (systolic BP>140 mmHg and/or diastolic BP>90 mmHg) during the first 2 years after discharge among patients with and without AKI. Patients who had AKI had higher cumulative incidence of elevated BP at 180 days, 360 days, 540 days, and 730 days after discharge, compared with patients who did not have AKI. Error bars represent 95% CIs. *P<0.05.
See this image and copyright information in PMC

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