Long-term renal outcome in patients with malignant hypertension: a retrospective cohort study

BMC Nephrology

Research Article

Sarah Bos¹  Bert-Jan van den Born¹  Fouad Amraoui¹  Liffert Vogt² 

[1] Departments of internal and vascular medicine, Academic Medical Centre, Amsterdam, The Netherlands;Departments of internal medicine and nephrology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands;

关键词: Malignant hypertension;    End-stage renal disease;    Chronic kidney disease;    Renal outcome;    Mortality;   

DOI  :  10.1186/1471-2369-13-71

 received in 2011-11-11, accepted in 2012-07-12,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundMalignant hypertension is frequently complicated by renal insufficiency. Although the survival of this hypertensive emergency has improved, recent data on renal outcome and its predictors are lacking. We assessed renal outcome and its predictors in patients with malignant hypertension.MethodsRetrospective analysis of patients admitted with malignant hypertension in Amsterdam, the Netherlands between August 1992–January 2010. Follow-up data on vital status, renal function and blood pressure (BP) were obtained from the outpatient department and from general practitioners. The primary composite endpoint was end-stage renal disease (ESRD) defined as the start of kidney replacement therapy (KRT) or ≥ 50% decline of estimated glomerular filtration rate (eGFR). The secondary endpoint was all cause mortality.ResultsA total of 120 patients admitted with malignant hypertension were included. After a median follow-up period of 67 months (IQR 28 to 108 months) the primary endpoint was reached by 37 (31%) patients, whereas 18 patients (15%) reached the secondary endpoint. Twenty-nine (24%) patients started KRT and 8 patients (7%) had an eGFR decline ≥ 50%. After the acute phase (> 3 months after admission), initial serum creatinine and follow-up BP were the main predictors of future ESRD with hazard ratios of 6.1 (95% CI, 2.2–17) for patients with initial serum creatinine ≥ 175 μmol /L and 4.3 (95% CI, 1.4–14) for patients with uncontrolled hypertension.ConclusionsProgressive renal function decline leading to ESRD remains a major threat to patients with malignant hypertension. BP control during follow-up was an important modifiable predictor of renal outcome.

【 授权许可】

CC BY   
© Amraoui et al.; licensee BioMed Central Ltd. 2012