Elevated BP after AKI

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.

Rhabdomyolysis among Critically Ill Combat Casualties: Long-Term Outcomes

“…While the link between HTN and AKI has been previously described [4,5], specific causes of AKI, such as rhabdomyolysis, have not been examined in detail. There are 2 potential pathways by which rhabdomyolysis might impact the long-term risk of HTN.…”

“…Rhabdomyolysis might predispose patients to poor long-term outcomes via one of 2 mechanisms. First, rhabdomyolysis is associated with AKI, which in turn is recognized to increase the subsequent risk of hypertension (HTN) [4,5], chronic kidney disease (CKD), end stage renal disease, mortality [6,7], and cardiovascular disease [7].…”

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

“…As the evidence linking AKI with loss of kidney function [45][46][47][77][78][79][80] , hypertension 81,82 , cardiovascular disease 49,50,83 , and death 46,[83][84][85][86][87] accumulates, determining the optimal care for this growing population is critical. The American Society of Nephrology AKI Advisory Group has highlighted the transition of care as a potential opportunity to reduce the long-term impact of AKI 88 , and hence, AKD.…”

Impact of Recent Clinical Trials on Nephrology Practice: Are We in a Stagnant Era?

“…The occurrence of AKI has been linked to a higher risk of incident or progressive CKD [79, 80], ESRD [81], and cardiovascular disease [82-84]. The incidence of AKI among critically ill patients has been described as high as 50%, and up to 10% of these patients require acute renal replacement therapy (RRT) [77, 85-87].…”