Type and severity of Kidney Impairment in patients admitted with a Hypertensive Emergency: a 5-year Retrospective Study 

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Partial kidney recovery is seen in some patients, while others rapidly progress to end-stage kidney disease. The aim of this study was to determine the severity, type and outcome of kidney impairment in patients with a hypertensive emergency (HE) in a resources-limited setting. Materials and Methods A hospital-based retrospective file analysis was carried out, and files of patients admitted with hypertensive emergency from the period 1 st of January 2019 to 31 st December 2023 were reviewed. A data extraction form was used to collect socio-demographic and clinical data from files. HE was defined according to the Joint National Committee 7 criteria, while the severity of kidney impairment (KI) was defined and graded using the Kidney Disease Improving Global Outcome (KDIGO) criteria. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 25. Results The prevalence of kidney impairment was 53.7%, with a significant increase in trend throughout the review. Acute Kidney Injury (AKI) was the most common type of KI with a prevalence of 53.2%. Eight out of ten patients with Chronic Kidney Disease (CKD) had a grade 5 CKD, and 1 out of 3 patients with AKI had a stage 3 AKI, with some requiring dialysis. Male gender (aor 4.01; 95% CI 2.13 – 7.76; p=0.01) and an increase in age (aOR 6.84; 95% CI 2.06 – 12.72; p=0.02) were significantly associated with Kidney impairment. Conclusion AKI was the most common type of kidney impairment. One out of two patients admitted with a hypertensive emergency had kidney impairment. Kidney recovery was good in AKI, and the overall mortality was high. Our findings suggest the need for scaling up of early hypertension screening before the age of forty for early detection and control. Hypertensive Emergency Kidney Impairment Figures Figure 1 INTRODUCTION Arterial hypertension (HTN) is a major public health problem around the world [ 1 ]. It is estimated that about 1 billion adults suffer from it, and this could reach 1.5 billion by 2025, and 9 million associated deaths annually. HTN is a major risk factor for cerebrovascular, cardiovascular and kidney morbidity and mortality[ 2 ]. Hypertensive crisis is one of the major acute complications of hypertension, and it is estimated that 1%-2% of hypertensive patients will develop a hypertensive crisis as a complication of untreated, poorly controlled hypertension or associated comorbidities [ 3 ]. A hypertensive crisis can either be a hypertensive urgency or a hypertensive emergency, based on the absence or presence of acute target organ damage, respectively[ 3 ]. Hypertensive emergency is defined as a blood pressure ≥ 180 for the systolic and/or ≥ 120 mm Hg for the diastolic, with evidence of acute end-organ damage, including acute kidney injury[ 4 ]. A study carried out at BRH in 2020 revealed a 6.2% prevalence of hypertensive crisis among admitted patients, with the main risk factor identified being CKD at 24.2%, while AKI was 7.1% as target organ damage [ 5 ]. This study aimed to determine the severity and type of kidney impairment of patients admitted with a hypertensive emergency at BRH. Patients and methods Study design A hospital-based retrospective review of files was carried out at the internal medicine unit of BRH. The Buea Regional Hospital (BRH) is a secondary healthcare facility which serves as a referral centre for the region. Patients with hypertensive emergencies are admitted from the outpatient department or directly from specialist consultation. The Buea hemodialysis centre has 17 (13 Bill Braun and 4 Fresenius Medical Care 40085 dialysis machines), 2 nephrologists, one general practitioner, 15 nurses and 3 support staff for a total of about 132 patients. The target population was patients admitted with hypertensive emergency from the period 1 st January 2019 to 31 st December 2023 at the BRH. Only files of adult patients admitted with hypertensive emergency during the study period were included in the study. Files with incomplete socio-demographic and clinical information were excluded from the study. Data collection We consulted the registers to identify patients admitted for hypertensive emergencies. For each file, blood pressure and other clinical parameters were those taken at admission. The first creatinine value was noted and subsequent value changes were used to define the type of kidney impairment Data was interred in a data extraction form, which consisted of socio-demographic factors (Gender, age, marital status, occupation, smoking, alcohol, and religion), Past medical history (history of hypertension, diabetes mellitus, chronic kidney disease, previous myocardial infarction, stroke, Heart failure all reported as stated in the files). Symptoms and signs (headache, oligo/anuria, blurred vision, dyspnoea, chest pain, hemiplegia/paresis, Loss of consciousness, cough, haemoglobinuria were noted as stated on admission. The comorbidities and the drug history were taken as reported in the files. The estimated glomerular filtration rate was calculated using the Modification of Diet in Renal Disease (MDRD) formula, and kidney impairment was graded using the KDIGO criteria. All methods were performed according to the relevant guidelines and regulations. Data management Data was input into an Excel sheet, cleaned and exported to SPSS v25 for statistical analysis. Continuous variables were presented as means and standard deviations, while categorical variables were presented in frequency tables. The Chi-square test and bivariate logistic regression were used to explore the association between variables. Multivariate logistic regression was used to identify factors associated with kidney impairment. A p-value of <0.05 was considered statistically significant, and odds ratios at a 95 % confidence interval were used to indicate the precision and strength of the association. Definition of terms 1) Chronic Kidney Disease was defined in our study as the presence of urine abnormalities (proteinuria, leukocyturia,or haematuria), and/or GFR <60 ml/min/1.73 present both at baseline and 3 months later , or a previous diagnosis of CKD. 2) Maintenance haemodialysis , Haemodialysis carried out at regular intervals to treat chronic renal failure for a period of >3 months. 3) AKI was defined in this study as an increase or decrease in serum creatinine of 0.3 mg/dl or more with a baseline serum creatinine < 1.5 mg/dl or a percentage increase or decrease in the serum creatinine concentration of ≥ 50% within seven days. For the baseline creatinine, whenever available, prehospitalisation Scr (community-acquired AKI) or the Scr on admission (hospital-acquired AKI) were used. When baseline Scr was missing, we considered absolute increase in the serum creatinine of 0.3 mg/l within 48 hours or observed 1.5 fold increase in creatinine in 7 days, knowing that lack of baseline creatinine when defining AKI has been shown to lead to underestimation of AKI and Higher mortality. 4) Kidney function recovery was assessed and calculated by the ratio of serum creatinine (sCr) to baseline sCr at the time of renal function assessment, according to the following criteria: (1) Total renal function recovery: when creatinine returns to the sCr baseline value; (2) Partial recovery: when sCr does not return to the baseline value but stays within a margin up to 1.5 times the baseline value; (3) No recovery: sCr stays at a value above 1.5 times to the baseline. Ethical considerations Ethical clearance was obtained from the Institutional Review Board of the Faculty of Health Sciences University of Buea (Reference N o 2023/2196-11/UB/SD/IRB/FHS) and administrative authorization to conduct the study was obtained from the Southwest Regional Delegate of Public Health (P42/MINSANTE/SWR/RDPH/CB.PT/617/623) and the Director of the Buea Regional Hospital (MPH/SWRDPH/BRH/IRB). As this was a retrospective study, the participants' consent was waived by the ethical committee. RESULTS Sociodemographic characteristics Of the 227 files reviewed, 120 (52.9%) were females, and the mean age of the patients was 53.8 + 15.1 years. The most affected age group was 38 - 55 years (44.5%). See Table 1 . Prevalence of kidney impairment among patients with hypertensive emergency Out of the 227 patients with hypertensive emergency, 122 (53.7%) had kidney impairment. Sixty-five (53.3%) of the patients were diagnosed of AKI, while 57 were diagnosed of CKD (25 known CKD and 32 newly diagnosed) (46.7%). The prevalence of kidney impairment increased over the period of study to double in four years with a P trend of (p=0.01). See Figure 1. Type and severity of kidney impairment in patients with hypertensive emergency Acute kidney injury represented 53% of patients with kidney impairment. One in three patients had grade 3 AKI, while CKD5 was more common in those with chronic kidney disease. See Table 2. Table 1: Socio-Demographic Characteristics of study participants Variable Frequency (n=227) Percentage (%) Mean Age (SD) 53.8 + (15.1) Age group 20 - 37 38 – 55 56 – 65 >65 Gender 25 101 53 48 11.1 44.5 23.3 21.1 Female 107 52.9 Male 120 47.1 Marital status Married 154 67.8 Single 42 18.5 Widow (er) 31 13.7 Occupation Employed 189 83.3% Unemployed 38 16.7 SD: Standard Deviation Table 2: Type and grade of kidney impairment in patients with hypertensive emergency Type of kidney impairment Frequency (n=122) Percentage (%) AKI 65 53.3 Stage 1 22 18.0 Stage 2 22 18.0 Stage 3 21 17.3 CKD 57 46.7 Grade 3B 3 2.5 Grade 4 9 7.4 Grade 5 45 36.8 AKI: acute kidney injury, CKD: chronic kidney disease Risk factors of kidney impairment in patients with hypertensive emergency On bivariate analysis, male gender, age ranging from 35 - 55 years, history of stroke, hypertension, alcohol consumption and smoking were significantly associated with kidney impairment. On multivariate analysis, male gender (p value < 0.001, aOR = 4.01, CI = 2.13 – 7.76) and age from 38 – 55 years (p value = 0.02, aOR = 6.85, CI = 2.06 – 12.72) were independently associated with kidney impairment. See Table 3. Outcome of patients with kidney impairment at discharge Among the 122 patients with kidney impairment, 66 (54%) had indication for hemodialysis and 54 (44.2%) had it done. The mean blood pressure at discharge was a systolic blood pressure of 153.6 + 21.4 mm/Hg and diastolic blood pressure of 95.9 + 17.8 mm/Hg, respectively. The average duration of hospitalisation was 8.9 + 6.0 days. Out of 227 patients admitted with hypertensive emergency during the period of study, 33 (14.5%) died. Two out of three patients who died had Kidney impairment. See Table 4. Table 3: Association between patients’ comorbidities and kidney impairment (Multivariate) Variable Proportion with kidney disease (%) Proportion without kidney disease (%) AOR P value Confidence interval 95% Gender Male 76(62.2) 31(29.5) 4.01 65 12.3 31.4 .59 0.21 0.26 – 1.34 Smoking Yes 4.0 1.0 3.34 0.34 0.55 – 1,38 No 96.0 99.0 Alcohol Yes 6.6 45.0 0.42 0.19 0.10 – 1.67 No 93.4 95.0 Diabetes Yes 12.3 18.0 0.54 0.17 No 87.7 82.0 0.22 – 1.29 Hypertension Yes 64.6 65.7 1.54 0.19 0.80 – 3.00 No 34.4 34.3 History of stroke Yes 2.5 13.3 0.13 0.21 0.24 – 2.76 No 97.5 86.7 AOR: Adjusted odds ratio Table 4: Outcome of patients with kidney impairment Variables Category Frequency Percentage Haemodialysis Yes Temporal (AKI) Permanent (CKD) Indicated but did not dialyse 54 5 49 12 44.2 4 40.2 9.8 Kidney recovery at discharge (AKI) Partial Complete No recovery 5 58 2 7.7 89.2 3.1 Death (N=33) AKI CKD 11 9 33.3 27.3 ESKD: End Stage Kidney Disease, AKI: Acute Kidney Injury, CKD: Chronic Kidney Disease DISCUSSION In our study, the prevalence of kidney impairment was 53.7% among patients with hypertensive emergency. The interaction between hypertension and CKD is complex and increases the risk of adverse cardiovascular and cerebrovascular outcomes [ 6 ]. This is particularly significant in the setting of resistant hypertension, commonly seen in patients with CKD[ 7 ]. The pathophysiology of CKD-associated hypertension is multi-factorial, with different mechanisms contributing to hypertension. These pathogenic mechanisms include sodium dysregulation, increased sympathetic nervous system and alterations in renin angiotensin aldosterone system activity [ 8 ]. Acute kidney injury is a defining criterion for HE, which occurs during malignant phases of hypertension. There is a loss in kidney blood flow autoregulation, leading to acute disruptive vascular and glomerular injuries, hence leading to kidney failure [ 9 ]. This is also because hypertension is considered both an initiator and a progressing factor for kidney impairment through multiple mechanisms, which include: nephrosclerosis (benign or malignant), glomerular damage, podocyte depletion due to high filtration pressure and tubulo-interstitial fibrosis [ 10 ]. This prevalence was consistent with the finding of Oh et al [ 11 ] in a study carried out in Vietnam, in which they reported a prevalence of 54.7%. However, the prevalence in our study was higher than the global prevalence of kidney impairment, which reported that only 8% of adults with hypertensive emergencies develop kidney impairment [ 12 ]. Probable reasons for this discrepancy is that, all the studies included in the meta-analysis and systemic review were carried at the emergency department were the sample size was larger, compare to our study that was carried in an internal medicine department with a smaller sample size and we did not considered proteinuria in defining our kidney impairment that could have mask some cases. In this study, we reported more cases of AKI than CKD. The pathophysiological mechanism of AKI in hypertensive emergencies is well known [ 10 ]. Malignant nephrosclerosis is characterised by fibrinoid necrosis of kidney arterioles and intimal hyperplasia leading to ischemia of the glomerular tuft and collapse, which is replaced by collagen filling the Bowman’s capsule. Moreover, hyperfiltration in the remaining glomeruli leads to hypertrophic glomeruli with enlarged tufts and dilated capillaries, eventually lesions typical of focal segmental glomerulosclerosis, resulting in AKI or progressing CKD to ESKD [ 13 ]. However, the finding of Aka et al. [ 14 ] In Ivory Coast revealed a higher prevalence of CKD was revealed at 78%. This high prevalence could be because his study was done in a nephrology unit, and he included other markers of kidney impairment like proteinuria, compared to ours, which was in an internal medicine unit. Their research was also on malignant hypertension, which manifests most of the time with several target organ damages, in which the kidney is involved most of the time. Our study also found an increase in trend of kidney impairment over the years and this was similar to the global increase in trend of kidney impairment[ 15 ]. This could be due to the increase in awareness, free screening, and referral of nephrologic cases to the single centreof the region and also due to the increase in cardiovascular diseases because of lifestyle changes. The most prevalent grade of kidney impairment among patients with HE was CKD (G5). This prevalence could be attributed to late presentation, late diagnosis and referral to specialist care. Most patients are referred when there is a need for KRT, masking the real prevalence of the other grades. A study carried out by Halle et al. [ 16 ] Showed that 73% of patients with CKD presented late at the nephrologist consultation. Moreover, up to 53% of patients presented with CKD grade 5. CKD can be the cause, consequence and or aggravating factor of hypertensive emergency[ 17 ]. This also makes it very difficult to identify if the CKD was a result of the hypertension or if the HE was precipitated by the CKD. However, our findings were not in line with Aka et al. [ 14 ] who had a proportion of G5 54.9%. This could be because their study was carried out in a nephrology unit where most of the patients are those with ESKD needing attention from the nephrologist. Male gender and an increase in age were significantly associated with kidney impairment. This could be due to the high comorbid state of men, and they are exposed to more cardiovascular risk factors, such as smoking and alcohol consumption, compared to women, who are less exposed to it and are protected by oestrogen (E2). An increase in age could be related to arterial stiffness, abnormalities of vascular reactivity, explaining the increase in kidney impairment with age. These findings were similar to those of Kaze et al. [ 7 ]In a study carried out in Cameroon. However, our findings were contrary to those of Feng et al. [ 18 ] China had more females than males. This difference could be because more females were enrolled in the study, and the study population were older, making both genders equal in cardiovascular risk factors. The history of smoking and hypertension were not significantly associated with kidney impairment in our study, but their adjusted odds ratios (3.34, 1.54), respectively, were high. This could be due to our small sample size and retrospective nature of the study, where the correct past medical history could not be obtained. This was similar to Benenson et al. [ 19 ] who had higher odds ratios for all the comorbidities, but it was not significantly associated with KI. However, all these comorbidities and risk factors were significant in other studies, including Kaze et al , Feng et al and Faye et al [ 7 , 18 , 20 ]. This could be explained due to their larger sample size. Our study revealed that 40.1% of patients with end-stage kidney disease with permanent kidney replacement therapy. Among those with AKI, 58 (89.2%) had a complete kidney recovery at discharge, 5 (7.7%) had a partial recovery, and 2 (3.1%) had no kidney recovery. The high prevalence of ESKD could be due to the inclusion of CKD patients in our study. This result was similar to findings by Aka et al. [ 14 ] Who reported a proportion of 53.1% of ESKD. However, in our study, the proportion of complete kidney recovery was higher than the 63.3% complete kidney recovery reported by Anitha et al. [ 21 ] In India. This could be due to their smaller sample size. We had a mortality rate of 16.3%. This high mortality could be explained by the poor stages of kidney impairment our patients had at presentation, late referral and diagnosis, with many dying before initiation of dialysis. This was similar to 16.4% reported by Siddiqi et al. [ 12 ]In the United States of America. However, it was lower than Aka et al. [ 14 ] With a death rate of 25.6%, which could be because his study was done in a nephrology unit with up to 98% having kidney impairment with poor prognosis, especially those with ESKD on dialysis. The mean duration of hospitalisation was 8.9 ± 6.0 days. This could be because 44.2% of our patients had severe kidney impairment requiring haemodialysis with several sessions and creatinine monitoring until the patients were stable before being discharged and followed up at the dialysis centre by Nephrologists. This was similar to the findings of Nkoke et al. [ 5 ] with 9.8 days, who had an increased mean days of hospitalisation in patients with hypertensive emergency compared to those with hypertensive urgency. However, it was higher than the 7.6 ± 9 days of Wan et al. [ 22 ]. This could be because they considered only those with HE and AKI, which require fewer dialysis sessions compared to those with CKD. Conclusion The prevalence of kidney impairment in patients admitted with hypertensive emergency at BRH was high, 1 out of 2 patients had kidney impairment. Acute kidney injury was the most common kidney impairment among those admitted with hypertensive emergency, 1 out of 2 patients with kidney impairment had AKI and CKD grade 5 was the most common grade of kidney impairment; 8 out of 10 patients with CKD had a grade 5 CKD. Kidney recovery was good among those admitted with acute kidney injury, the mortality rate was high, 1 out of 6 patients admitted with KI died. Male gender and advanced age were independent predictors of kidney impairment in patients admitted with a hypertensive emergency at BRH. Our findings suggest the need for scaling up of early hypertension screening before the age of forty for early detection and control. Declarations Ethics approval Ethical clearance was obtained from the Faculty of Health Sciences, University of Buea (FHS), and its Institutional Review Board (Reference No. 2023/2196-11/UB/SD/IRB/FHS). Administrative clearance was obtained from the Regional Delegate of Public Health of the Southwest region and hospital authorities of Yaoundé, Douala and Buea. Human Ethics and Consent to Participate declarations: not applicable Consent for publication: Not applicable Clinical trial number: not applicable. Availability of data and materials The materials described in the manuscript, including all relevant raw data, will be freely available to any scientist wishing to use them for non-commercial purposes. The data that support the findings of this study are then available from the corresponding author ( [email protected] ) upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding The authors did not receive any funding for the study or the publication Authors' contributions D.G.T., A.T., C.K., C.D.N., R.G.B., and M.P.H. were responsible entirely for the conception and design of the study. D.G.T, M.P.H, A.T, C.K, I.K designed data collection tools, collected and monitored data collection for the whole trial, cleaned, analysed and interpreted the data, and drafted the manuscript. D.G.T., A.T., C.N., C.D.N., and M.P.H. revised the paper and produced the final manuscript. All the authors have read and approved the final manuscript. Acknowledgements Not applicable References Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. The Lancet. 2005;365:217–23. Bloch MJ. Worldwide prevalence of hypertension exceeds 1.3 billion. Journal of the American Society of Hypertension. 2016;10:753–4. Papadopoulos DP, Mourouzis I, Thomopoulos C, Makris T, Papademetriou V. Hypertension crisis. 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Prevalence and risk factors of chronic kidney disease in an African semi-urban area: Results from a cross-sectional survey in Gueoul, Senegal. Saudi J Kidney Dis Transplant Off Publ Saudi Cent Organ Transplantation Saudi Arab. 2017;28:1389–96. Anitha A, Babu K. A 10-year Study: Renal Outcomes in Patients with Accelerated Hypertension and Renal Dysfunction. Indian Journal of Nephrology. 2020;30:409–15 . Wan S-H, Slusser JP, Hodge DO, Chen HH. The Vascular-Renal Connection in Patients Hospitalised With Hypertensive Crisis: A Population-Based Study. Mayo Clinic Proceedings: Innovation, Quality and Outcomes. 2018;2:148–54. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5768615","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":474604112,"identity":"cba09322-6736-4cb3-8557-a645005c7d0f","order_by":0,"name":"Denis Georges Teuwafeu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYDCCAxCKn4GB+QADYwNRWpjBlGQDA1sCyVp4DIjTwneA/+Bj3jY7CX6JnG8SP3fYyDGwHz66AZ8WyQPMzMa8bckSkjNyt0n2nkkzZuBJS7uBT4vBAWY2ad5tzHUGN3K3SfC2HU5skOAxI6SF/TfvtnoJ+xs5zyT/EqmFjZl322EJA4kcoHXEaJE8zGwsOfffcQmJM8+MrWXb0ozZCPmF73jjww9vzlRL8LcnP7z5ts1Gjp/98DG8WhiYEUwWCRDJhlc5uu4PpKgeBaNgFIyCkQMA7mxGysfY4OkAAAAASUVORK5CYII=","orcid":"","institution":"University Of Buea","correspondingAuthor":true,"prefix":"","firstName":"Denis","middleName":"Georges","lastName":"Teuwafeu","suffix":""},{"id":474604115,"identity":"d93b2e47-f6d7-41d1-bb3a-a7f780de2f9e","order_by":1,"name":"Ahmadou Tidjani","email":"","orcid":"","institution":"University Of Buea","correspondingAuthor":false,"prefix":"","firstName":"Ahmadou","middleName":"","lastName":"Tidjani","suffix":""},{"id":474604117,"identity":"0d110476-6d5f-4a6d-ab7f-981fba15cc98","order_by":2,"name":"Clovis Nkoke","email":"","orcid":"","institution":"University Of Buea","correspondingAuthor":false,"prefix":"","firstName":"Clovis","middleName":"","lastName":"Nkoke","suffix":""},{"id":474604120,"identity":"0a0b2999-6b22-4844-9235-0837d7b0d5b5","order_by":3,"name":"Ronald Gobina Mbua","email":"","orcid":"","institution":"University Of Buea","correspondingAuthor":false,"prefix":"","firstName":"Ronald","middleName":"Gobina","lastName":"Mbua","suffix":""},{"id":474604123,"identity":"7d8d6342-eeb2-4997-96d4-008cd8e7a7a3","order_by":4,"name":"Cyrille Ducquesne Nkouonlack","email":"","orcid":"","institution":"University Of Buea","correspondingAuthor":false,"prefix":"","firstName":"Cyrille","middleName":"Ducquesne","lastName":"Nkouonlack","suffix":""},{"id":474604125,"identity":"c508cd0b-693c-4ab9-8178-2290b2285600","order_by":5,"name":"Ismaila Karimu","email":"","orcid":"","institution":"University Of Buea","correspondingAuthor":false,"prefix":"","firstName":"Ismaila","middleName":"","lastName":"Karimu","suffix":""},{"id":474604126,"identity":"89852d30-567f-48e6-bbbc-52a4eda406e5","order_by":6,"name":"Marie-patrice Halle","email":"","orcid":"","institution":"University of Douala","correspondingAuthor":false,"prefix":"","firstName":"Marie-patrice","middleName":"","lastName":"Halle","suffix":""}],"badges":[],"createdAt":"2025-01-05 15:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5768615/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5768615/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85348828,"identity":"76240f3d-8b71-4ef4-9829-e678a147e1d6","added_by":"auto","created_at":"2025-06-25 02:29:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":27731,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe trend of kidney impairment in patients with hypertensive emergencies throughout the study from 2019 to 2023.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5768615/v1/5d19306e7106a3e55f5fbeba.png"},{"id":93571199,"identity":"62013f11-3275-4f42-b6cd-2163b6437f69","added_by":"auto","created_at":"2025-10-15 09:03:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1201235,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5768615/v1/57617eb2-4624-4752-aa40-169edd2006de.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Type and severity of Kidney Impairment in patients admitted with a Hypertensive Emergency: a 5-year Retrospective Study ","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eArterial hypertension (HTN) is a major public health problem around the world [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is estimated that about 1\u0026nbsp;billion adults suffer from it, and this could reach 1.5\u0026nbsp;billion by 2025, and 9\u0026nbsp;million associated deaths annually. HTN is a major risk factor for cerebrovascular, cardiovascular and kidney morbidity and mortality[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Hypertensive crisis is one of the major acute complications of hypertension, and it is estimated that 1%-2% of hypertensive patients will develop a hypertensive crisis as a complication of untreated, poorly controlled hypertension or associated comorbidities [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A hypertensive crisis can either be a hypertensive urgency or a hypertensive emergency, based on the absence or presence of acute target organ damage, respectively[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHypertensive emergency is defined as a blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;180 for the systolic and/or \u0026ge;\u0026thinsp;120 mm Hg for the diastolic, with evidence of acute end-organ damage, including acute kidney injury[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A study carried out at BRH in 2020 revealed a 6.2% prevalence of hypertensive crisis among admitted patients, with the main risk factor identified being CKD at 24.2%, while AKI was 7.1% as target organ damage [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This study aimed to determine the severity and type of kidney impairment of patients admitted with a hypertensive emergency at BRH.\u003c/p\u003e"},{"header":"Patients and methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA hospital-based retrospective review of files was carried out at the internal medicine unit of BRH. The Buea Regional Hospital (BRH) is a secondary healthcare facility which serves as a referral centre for the region. Patients with hypertensive emergencies are admitted from the outpatient department or directly from specialist consultation.\u0026nbsp;The Buea hemodialysis centre has 17 (13 Bill Braun and 4 Fresenius Medical Care 40085 dialysis machines), 2 nephrologists, one general practitioner, 15 nurses and 3 support staff for a total of about 132 patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe target population was patients admitted with hypertensive emergency from the period 1\u003csup\u003est\u003c/sup\u003e January 2019 to 31\u003csup\u003est\u003c/sup\u003e December 2023 at the BRH. Only files of adult patients admitted with hypertensive emergency during the study period were included in the study. Files with incomplete socio-demographic and clinical information were excluded from the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe consulted the registers to identify patients admitted for hypertensive emergencies. For each file, blood pressure and other clinical parameters were those taken at admission. The first creatinine value was noted and subsequent value changes were used to define the type of kidney impairment Data was interred in a data extraction form, which consisted of socio-demographic factors (Gender, age, marital status, occupation, smoking, alcohol, and religion), Past medical history (history of hypertension, diabetes mellitus, chronic kidney disease, previous myocardial infarction, stroke, Heart failure all reported as stated in the files). Symptoms and signs (headache, oligo/anuria, blurred vision, dyspnoea, chest pain, hemiplegia/paresis, Loss of consciousness, cough, haemoglobinuria were noted as stated on admission. The comorbidities and the drug history were taken as reported in the files. The estimated glomerular filtration rate was calculated using the Modification of Diet in Renal Disease (MDRD) formula, and kidney impairment was graded using the KDIGO criteria.\u003c/p\u003e\n\u003cp\u003eAll methods were performed according to the relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData was input into an Excel sheet, cleaned and exported to SPSS v25 for statistical analysis. Continuous variables were presented as means and standard deviations, while categorical variables were presented in frequency tables. The Chi-square test and bivariate logistic regression were used to explore the association between variables. Multivariate logistic regression was used to identify factors associated with kidney impairment. A p-value of \u0026lt;0.05 was considered statistically significant, and odds ratios at a 95 % confidence interval were used to indicate the precision and strength of the association.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDefinition of terms\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1)\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Chronic Kidney Disease\u0026nbsp;\u003c/strong\u003ewas defined in our study as the presence of urine abnormalities (proteinuria, leukocyturia,or haematuria), and/or GFR \u0026lt;60 ml/min/1.73 present both at baseline and 3 months later\u003cstrong\u003e, or a previous diagnosis of CKD.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e2) \u003cstrong\u003eMaintenance haemodialysis\u003c/strong\u003e, Haemodialysis carried out at regular intervals to treat chronic renal failure for a period of \u0026gt;3 months.\u003c/p\u003e\n\u003cp\u003e3) \u003cstrong\u003eAKI\u003c/strong\u003e was defined in this study as an increase or decrease in serum creatinine of 0.3 mg/dl or more with a baseline serum creatinine \u0026lt; 1.5 mg/dl or a percentage increase or decrease in the serum creatinine concentration of ≥ 50% within seven days. For the baseline creatinine, whenever available, prehospitalisation Scr (community-acquired AKI) or the Scr on admission (hospital-acquired AKI) were used. When baseline Scr was missing, we considered absolute increase in the serum creatinine of 0.3 mg/l within 48 hours or observed 1.5 fold increase in creatinine in 7 days, knowing that lack of baseline creatinine when defining AKI has been shown to lead to underestimation of AKI and Higher mortality.\u003c/p\u003e\n\u003cp\u003e4) \u003cstrong\u003eKidney function recovery\u003c/strong\u003e was assessed and calculated by the ratio of serum creatinine (sCr) to baseline sCr at the time of renal function assessment, according to the following criteria: (1) Total renal function recovery: when creatinine returns to the sCr baseline value; (2) Partial recovery: when sCr does not return to the baseline value but stays within a margin up to 1.5 times the baseline value; (3) No recovery: sCr stays at a value above 1.5 times to the baseline.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003econsiderations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from the Institutional Review Board of the Faculty of Health Sciences University of Buea (Reference N\u003csup\u003eo\u003c/sup\u003e2023/2196-11/UB/SD/IRB/FHS) and administrative authorization to conduct the study was obtained from the Southwest Regional Delegate of Public Health (P42/MINSANTE/SWR/RDPH/CB.PT/617/623) and the Director of the Buea Regional Hospital (MPH/SWRDPH/BRH/IRB). As this was a retrospective study, the participants' consent was waived by the ethical committee.\u0026nbsp;\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eSociodemographic characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 227 files reviewed, 120 (52.9%) were females, and the mean age of the patients was 53.8 \u003cu\u003e+\u003c/u\u003e 15.1 years. The most affected age group was 38 - 55 years (44.5%). \u003cstrong\u003eSee Table 1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of kidney impairment among patients with hypertensive emergency\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of the 227 patients with hypertensive emergency, 122 (53.7%) had kidney impairment. Sixty-five (53.3%) of the patients were diagnosed of AKI, while 57 were diagnosed of CKD (25 known CKD and 32 newly diagnosed) (46.7%). The prevalence of kidney impairment increased over the period of study to double in four years with a P trend of (p=0.01). \u003cstrong\u003eSee Figure 1.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eType and severity of kidney impairment in patients with hypertensive emergency\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcute kidney injury represented 53% of patients with kidney impairment. One in three patients had grade 3 AKI, while CKD5 was more common in those with chronic kidney disease. \u003cstrong\u003eSee Table 2.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Socio-Demographic Characteristics of study participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 265px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n=227)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 265px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Age (SD)\u0026nbsp;\u003c/strong\u003e53.8 \u003cu\u003e+\u003c/u\u003e (15.1)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAge group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e20 - 37\u003c/p\u003e\n \u003cp\u003e38 \u0026ndash; 55\u003c/p\u003e\n \u003cp\u003e56 \u0026ndash; 65\u003c/p\u003e\n \u003cp\u003e\u0026gt;65\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003cp\u003e44.5\u003c/p\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003cp\u003e21.1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 265px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e52.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 265px;\"\u003e\n \u003cp\u003eMale \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e47.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 265px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 265px;\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e67.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 265px;\"\u003e\n \u003cp\u003eSingle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 265px;\"\u003e\n \u003cp\u003eWidow (er)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 265px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 265px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 265px;\"\u003e\n \u003cp\u003eUnemployed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSD: Standard Deviation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Type and grade of kidney impairment in patients with hypertensive emergency\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"620\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of kidney impairment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n=122)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAKI\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e53.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eStage 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eStage 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eStage 3\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e17.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCKD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e46.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eGrade 3B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eGrade 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eGrade 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e36.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAKI: acute kidney injury, \u0026nbsp; CKD: chronic kidney disease\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRisk factors of kidney impairment in patients with hypertensive emergency\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOn bivariate analysis, male gender, age ranging from 35 - 55 years, history of stroke, hypertension, alcohol consumption and smoking were significantly associated with kidney impairment. On multivariate analysis, male gender (p value \u0026lt; 0.001, aOR = 4.01, CI = 2.13 \u0026ndash; 7.76) and age from 38 \u0026ndash; 55 years (p value = 0.02, aOR = 6.85, CI = 2.06 \u0026ndash; 12.72) were independently associated with kidney impairment. \u003cstrong\u003eSee Table 3.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome of patients with kidney impairment at discharge\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 122 patients with kidney impairment, 66 (54%) had indication for hemodialysis and 54 (44.2%) had it done. The mean blood pressure at discharge was a systolic blood pressure of 153.6 \u003cu\u003e+\u003c/u\u003e 21.4 mm/Hg and diastolic blood pressure of 95.9 \u003cu\u003e+\u003c/u\u003e 17.8 mm/Hg, respectively. The average duration of hospitalisation was 8.9 \u003cu\u003e+\u003c/u\u003e 6.0 days.\u003c/p\u003e\n\u003cp\u003eOut of 227 patients admitted with hypertensive emergency during the period of study, 33 (14.5%) died. Two out of three patients who died had Kidney impairment. \u003cstrong\u003eSee Table 4.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Association between patients\u0026rsquo; comorbidities and kidney impairment (Multivariate)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"640\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProportion with kidney disease (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProportion without kidney disease (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP value\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConfidence interval 95%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e76(62.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e31(29.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2.13 \u0026ndash; 7.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e46(37.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e74(70.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e20 \u0026ndash; 37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e17.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e38 \u0026ndash; 55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e51.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e36.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2.06 \u0026ndash; 12.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e56 \u0026ndash; 65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e18.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.20 \u0026ndash; 4.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026gt;65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e31.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.26 \u0026ndash; 1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Smoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.55 \u0026ndash; 1,38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e96.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e99.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e45.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.10 \u0026ndash; 1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e93.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e95.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e87.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e82.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.22 \u0026ndash; 1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e64.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e65.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.80 \u0026ndash; 3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e34.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e34.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of stroke\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.24 \u0026ndash; 2.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e97.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e86.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable cellpadding=\"0\" cellspacing=\"0\"\u003e\u003c/table\u003e\n\u003cp\u003eAOR: Adjusted odds ratio\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Outcome of patients with kidney impairment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eHaemodialysis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTemporal (AKI)\u003c/p\u003e\n \u003cp\u003ePermanent (CKD)\u003c/p\u003e\n \u003cp\u003eIndicated but did not dialyse \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e44.2\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e40.2\u003c/p\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eKidney recovery at discharge (AKI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003ePartial\u003c/p\u003e\n \u003cp\u003eComplete\u003c/p\u003e\n \u003cp\u003eNo recovery\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003cp\u003e89.2\u003c/p\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eDeath\u003c/p\u003e\n \u003cp\u003e(N=33)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003eAKI\u003c/p\u003e\n \u003cp\u003eCKD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003cp\u003e27.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eESKD: End Stage Kidney Disease, AKI: Acute Kidney Injury, CKD: Chronic Kidney Disease\u003c/p\u003e\n"},{"header":"DISCUSSION","content":"\u003cp\u003eIn our study, the prevalence of kidney impairment was 53.7% among patients with hypertensive emergency. The interaction between hypertension and CKD is complex and increases the risk of adverse cardiovascular and cerebrovascular outcomes [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This is particularly significant in the setting of resistant hypertension, commonly seen in patients with CKD[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The pathophysiology of CKD-associated hypertension is multi-factorial, with different mechanisms contributing to hypertension. These pathogenic mechanisms include sodium dysregulation, increased sympathetic nervous system and alterations in renin angiotensin aldosterone system activity [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Acute kidney injury is a defining criterion for HE, which occurs during malignant phases of hypertension. There is a loss in kidney blood flow autoregulation, leading to acute disruptive vascular and glomerular injuries, hence leading to kidney failure [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This is also because hypertension is considered both an initiator and a progressing factor for kidney impairment through multiple mechanisms, which include: nephrosclerosis (benign or malignant), glomerular damage, podocyte depletion due to high filtration pressure and tubulo-interstitial fibrosis [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This prevalence was consistent with the finding of Oh \u003cem\u003eet al\u003c/em\u003e [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] in a study carried out in Vietnam, in which they reported a prevalence of 54.7%. However, the prevalence in our study was higher than the global prevalence of kidney impairment, which reported that only 8% of adults with hypertensive emergencies develop kidney impairment [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Probable reasons for this discrepancy is that, all the studies included in the meta-analysis and systemic review were carried at the emergency department were the sample size was larger, compare to our study that was carried in an internal medicine department with a smaller sample size and we did not considered proteinuria in defining our kidney impairment that could have mask some cases.\u003c/p\u003e \u003cp\u003eIn this study, we reported more cases of AKI than CKD. The pathophysiological mechanism of AKI in hypertensive emergencies is well known [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Malignant nephrosclerosis is characterised by fibrinoid necrosis of kidney arterioles and intimal hyperplasia leading to ischemia of the glomerular tuft and collapse, which is replaced by collagen filling the Bowman\u0026rsquo;s capsule. Moreover, hyperfiltration in the remaining glomeruli leads to hypertrophic glomeruli with enlarged tufts and dilated capillaries, eventually lesions typical of focal segmental glomerulosclerosis, resulting in AKI or progressing CKD to ESKD [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, the finding of Aka \u003cem\u003eet al.\u003c/em\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] In Ivory Coast revealed a higher prevalence of CKD was revealed at 78%. This high prevalence could be because his study was done in a nephrology unit, and he included other markers of kidney impairment like proteinuria, compared to ours, which was in an internal medicine unit. Their research was also on malignant hypertension, which manifests most of the time with several target organ damages, in which the kidney is involved most of the time.\u003c/p\u003e \u003cp\u003eOur study also found an increase in trend of kidney impairment over the years and this was similar to the global increase in trend of kidney impairment[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This could be due to the increase in awareness, free screening, and referral of nephrologic cases to the single centreof the region and also due to the increase in cardiovascular diseases because of lifestyle changes.\u003c/p\u003e \u003cp\u003eThe most prevalent grade of kidney impairment among patients with HE was CKD (G5). This prevalence could be attributed to late presentation, late diagnosis and referral to specialist care. Most patients are referred when there is a need for KRT, masking the real prevalence of the other grades. A study carried out by Halle \u003cem\u003eet al.\u003c/em\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] Showed that 73% of patients with CKD presented late at the nephrologist consultation. Moreover, up to 53% of patients presented with CKD grade 5. CKD can be the cause, consequence and or aggravating factor of hypertensive emergency[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This also makes it very difficult to identify if the CKD was a result of the hypertension or if the HE was precipitated by the CKD. However, our findings were not in line with Aka \u003cem\u003eet al.\u003c/em\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] who had a proportion of G5 54.9%. This could be because their study was carried out in a nephrology unit where most of the patients are those with ESKD needing attention from the nephrologist.\u003c/p\u003e \u003cp\u003eMale gender and an increase in age were significantly associated with kidney impairment. This could be due to the high comorbid state of men, and they are exposed to more cardiovascular risk factors, such as smoking and alcohol consumption, compared to women, who are less exposed to it and are protected by oestrogen (E2). An increase in age could be related to arterial stiffness, abnormalities of vascular reactivity, explaining the increase in kidney impairment with age. These findings were similar to those of Kaze \u003cem\u003eet al.\u003c/em\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]In a study carried out in Cameroon. However, our findings were contrary to those of Feng \u003cem\u003eet al.\u003c/em\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] China had more females than males. This difference could be because more females were enrolled in the study, and the study population were older, making both genders equal in cardiovascular risk factors. The history of smoking and hypertension were not significantly associated with kidney impairment in our study, but their adjusted odds ratios (3.34, 1.54), respectively, were high. This could be due to our small sample size and retrospective nature of the study, where the correct past medical history could not be obtained. This was similar to Benenson \u003cem\u003eet al.\u003c/em\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] who had higher odds ratios for all the comorbidities, but it was not significantly associated with KI. However, all these comorbidities and risk factors were significant in other studies, including Kaze \u003cem\u003eet al\u003c/em\u003e, Feng \u003cem\u003eet al\u003c/em\u003e and Faye \u003cem\u003eet al\u003c/em\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This could be explained due to their larger sample size.\u003c/p\u003e \u003cp\u003eOur study revealed that 40.1% of patients with end-stage kidney disease with permanent kidney replacement therapy. Among those with AKI, 58 (89.2%) had a complete kidney recovery at discharge, 5 (7.7%) had a partial recovery, and 2 (3.1%) had no kidney recovery. The high prevalence of ESKD could be due to the inclusion of CKD patients in our study. This result was similar to findings by Aka \u003cem\u003eet al.\u003c/em\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Who reported a proportion of 53.1% of ESKD. However, in our study, the proportion of complete kidney recovery was higher than the 63.3% complete kidney recovery reported by Anitha \u003cem\u003eet al.\u003c/em\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] In India. This could be due to their smaller sample size.\u003c/p\u003e \u003cp\u003eWe had a mortality rate of 16.3%. This high mortality could be explained by the poor stages of kidney impairment our patients had at presentation, late referral and diagnosis, with many dying before initiation of dialysis. This was similar to 16.4% reported by Siddiqi \u003cem\u003eet al.\u003c/em\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]In the United States of America. However, it was lower than Aka \u003cem\u003eet al.\u003c/em\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] With a death rate of 25.6%, which could be because his study was done in a nephrology unit with up to 98% having kidney impairment with poor prognosis, especially those with ESKD on dialysis.\u003c/p\u003e \u003cp\u003eThe mean duration of hospitalisation was 8.9\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;6.0 days. This could be because 44.2% of our patients had severe kidney impairment requiring haemodialysis with several sessions and creatinine monitoring until the patients were stable before being discharged and followed up at the dialysis centre by Nephrologists. This was similar to the findings of Nkoke \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] with 9.8 days, who had an increased mean days of hospitalisation in patients with hypertensive emergency compared to those with hypertensive urgency. However, it was higher than the 7.6\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;9 days of Wan \u003cem\u003eet al.\u003c/em\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This could be because they considered only those with HE and AKI, which require fewer dialysis sessions compared to those with CKD.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe prevalence of kidney impairment in patients admitted with hypertensive emergency at BRH was high, 1 out of 2 patients had kidney impairment. Acute kidney injury was the most common kidney impairment among those admitted with hypertensive emergency, 1 out of 2 patients with kidney impairment had AKI and CKD grade 5 was the most common grade of kidney impairment; 8 out of 10 patients with CKD had a grade 5 CKD. Kidney recovery was good among those admitted with acute kidney injury, the mortality rate was high, 1 out of 6 patients admitted with KI died. Male gender and advanced age were independent predictors of kidney impairment in patients admitted with a hypertensive emergency at BRH. Our findings suggest the need for scaling up of early hypertension screening before the age of forty for early detection and control.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from the Faculty of Health Sciences, University of Buea (FHS), and its Institutional Review Board (Reference No. 2023/2196-11/UB/SD/IRB/FHS). Administrative clearance was obtained from the Regional Delegate of Public Health of\u0026nbsp;the Southwest\u0026nbsp;region\u0026nbsp;and\u0026nbsp;hospital authorities of Yaound\u0026eacute;, Douala and Buea.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations:\u0026nbsp;\u003c/strong\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe materials described in the manuscript, including all relevant raw data, will be freely available to any scientist wishing to use them for non-commercial purposes. The data that support the findings of this study are then available from the corresponding author ([email protected]) upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive any funding for the study or the publication\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eD.G.T., A.T., C.K., C.D.N., R.G.B., and M.P.H. were responsible entirely for the conception and design of the study. D.G.T, M.P.H, A.T, C.K, I.K designed data collection tools, collected and monitored data collection for the whole trial, cleaned, analysed and interpreted the data, and drafted the manuscript. D.G.T., A.T., C.N., C.D.N.,\u0026nbsp;and\u0026nbsp;M.P.H. revised the paper and\u0026nbsp;produced\u0026nbsp;the final manuscript. All the authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eKearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. \u003cem\u003eThe Lancet. 2005;365:217\u0026ndash;23.\u0026nbsp;\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eBloch MJ. Worldwide prevalence of hypertension exceeds 1.3 billion. \u003cem\u003eJournal of the American Society of Hypertension. 2016;10:753\u0026ndash;4.\u0026nbsp;\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003ePapadopoulos DP, Mourouzis I, Thomopoulos C, Makris T, Papademetriou V. \u003cem\u003eHypertension crisis. Blood Pressure. 2010;19:328\u0026ndash;36.\u0026nbsp;\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eChobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.\u003cem\u003eJournal of the American Medical Association.\u003c/em\u003e\u003cem\u003e.\u0026nbsp;\u003c/em\u003e\u003cem\u003e2003;289:2560\u0026ndash;72.\u0026nbsp;\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eNkoke C, Noubiap JJ, Dzudie A, M. Jingi A, Njume D, Teuwafeu D, et al. Epidemiology of hypertensive crisis in the Buea Regional Hospital, Cameroon. \u003cem\u003eJournal of Clinical Hypertension. 2020;22:2105\u0026ndash;10.\u0026nbsp;\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eTanner RM, Calhoun DA, Bell EK, Bowling CB, Guti\u0026eacute;rrez OM, Irvin MR, et al. Prevalence of Apparent Treatment-Resistant Hypertension among Individuals with CKD. \u003cem\u003eClinical Journal of the American Society of Nephrologists. 2013;8:1583\u0026ndash;90.\u0026nbsp;\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eKaze FF, Kengne A, Magatsing CT, Halle M, Yiagnigni E, Ngu KB. Prevalence and Determinants of Chronic Kidney Disease Among Hypertensive Cameroonians According to Three Common Estimators of the Glomerular Filtration Rate.\u003cem\u003e\u0026nbsp;Journal of Clinical Hypertension. 2016;18:408\u0026ndash;14.\u0026nbsp;\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eHamrahian SM, Falkner B. Hypertension in Chronic Kidney Disease. In: Islam, Mds, editor. \u003cem\u003eHypertension Basic Research Clinical Practice [Internet]. Cham: Springer International Publishing; 2016 [cited 2024 May 20]. p. 307\u0026ndash;25. Available from: http://link.springer.com/10.1007/5584_2016_84\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eRazzaque MS, Azouz A, Shinagawa T, Taguchi T. Factors Regulating the Progression of Hypertensive Nephrosclerosis. In: Razzaque MS, Taguchi T, editors.\u003cem\u003eContribution in Nephrology\u003c/em\u003e\u003cem\u003e[Internet]. Basel: KARGER; 2003 [cited 2023 Nov 6]. p. 173\u0026ndash;86. Available from: https://www.karger.com/Article/FullText/71743\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eCostantino VV, Gil Lorenzo AF, Bocanegra V, Vall\u0026eacute;s PG. Molecular Mechanisms of Hypertensive Nephropathy: Renoprotective Effect of Losartan through Hsp70. Cells. 2021;10:3146.\u003c/li\u003e\n \u003cli\u003eOh JS, Lee CH, Park JI, Park HK, Hwang JK. Hypertension-Mediated Organ Damage and Long-term Cardiovascular Outcomes in Asian Hypertensive Patients without Prior Cardiovascular Disease.\u003cem\u003eJournal of Korean Medical Science\u003c/em\u003e. \u003cem\u003e2020;35:e400.\u0026nbsp;\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eSiddiqi TJ, Usman MS, Rashid AM, Javaid SS, Ahmed A, Clark D, et al. Clinical Outcomes in Hypertensive Emergency: A Systematic Review and Meta‐Analysis. \u003cem\u003eJournal of the American Heart Association\u003c/em\u003e. \u003cem\u003e2023;12:e029355.\u0026nbsp;\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eHallan SI, \u0026Oslash;vrehus MA, Bj\u0026oslash;rneklett R, Aasar\u0026oslash;d KI, Fogo AB, Ix JH. Hypertensive nephrosclerosis: wider kidney biopsy indications may be needed to improve diagnostics. \u003cem\u003eJournal Internal Medicine\u003c/em\u003e. 2021;289:69\u0026ndash;83.\u003c/li\u003e\n \u003cli\u003eAka JA, Guei CM, Konan SD, Diopoh PS, Sanogo S, Yao HK. [A study on malignant arterial hypertension: about 168 cases at the unit of nephrology-internal medicine of the University Hospital Centre, Treichville, Abidjan]. \u003cem\u003ePan African Medical Journal. 2021;38:305.\u0026nbsp;\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eZucchelli P, Zuccal\u0026aacute; A. Progression of renal failure and hypertensive nephrosclerosis. \u003cem\u003eKidney International Supplement\u003c/em\u003e. 1998;68:S55-59.\u003c/li\u003e\n \u003cli\u003eMarie Patrice H, Joiven N, Hermine F, Jean Yves B, Folefack Fran\u0026ccedil;ois K, Enow Gloria A. Factors associated with late presentation of patients with chronic kidney disease in nephrology consultation in Cameroon descriptive cross-sectional study. \u003cem\u003eRenal Failure. 2019;41:384\u0026ndash;92.\u0026nbsp;\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eLengani A, Samadoulougou A, Ciss\u0026eacute; M. [Characteristics of renal disease in hypertensive morbidities in adults in Burkina Faso]. \u003cem\u003eArchives des Maladies C\u0026oelig;ur et Vaisseaux. 2000;93:1053\u0026ndash;7.\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eFeng T, Xu Y, Zheng J, Wang X, Li Y, Wang Y, et al. Prevalence of and risk factors for chronic kidney disease in ten metropolitan areas of China: a cross-sectional study using three kidney damage markers. \u003cem\u003eRenal Failure. 2023;45:2170243.\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eBenenson I, Waldron FA, Jadotte YT, Dreker MP, Holly C. Risk factors for hypertensive crisis in adult patients: a systematic review.\u003cem\u003e\u0026nbsp;Joanna Briggs Institute Evidence Synthesis. 2021;19:1292\u0026ndash;327.\u0026nbsp;\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eFaye M, Lemrabott AT, Ciss\u0026eacute; MM, Fall K, Keita Y, Ngaide AA, et al. Prevalence and risk factors of chronic kidney disease in an African semi-urban area: Results from a cross-sectional survey in Gueoul, Senegal. Saudi J Kidney Dis Transplant Off Publ Saudi Cent Organ Transplantation Saudi Arab. 2017;28:1389\u0026ndash;96.\u003c/li\u003e\n \u003cli\u003eAnitha A, Babu K. A 10-year Study: Renal Outcomes in Patients with Accelerated Hypertension and Renal Dysfunction. \u003cem\u003eIndian Journal of Nephrology. 2020;30:409\u0026ndash;15\u003c/em\u003e.\u003c/li\u003e\n \u003cli\u003eWan S-H, Slusser JP, Hodge DO, Chen HH. The Vascular-Renal Connection in Patients Hospitalised With Hypertensive Crisis: A Population-Based Study.\u003cem\u003eMayo Clinic Proceedings: Innovation, Quality and Outcomes. 2018;2:148\u0026ndash;54.\u0026nbsp;\u003c/em\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hypertensive Emergency, Kidney Impairment","lastPublishedDoi":"10.21203/rs.3.rs-5768615/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5768615/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong patients with hypertensive emergency, acute worsening of kidney function, occur in 22% - 55%. Partial kidney recovery is seen in some patients, while others rapidly progress to end-stage kidney disease. The aim of this study was to determine the severity, type and outcome of kidney impairment in patients with a hypertensive emergency (HE) in a resources-limited setting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA hospital-based retrospective file analysis was carried out, and files of patients admitted with hypertensive emergency from the period 1\u003csup\u003est\u003c/sup\u003e of January 2019 to 31\u003csup\u003est \u003c/sup\u003eDecember 2023 were reviewed. A data extraction form was used to collect socio-demographic and clinical data from files. HE was defined according to the Joint National Committee 7 criteria, while the severity of kidney impairment (KI) was defined and graded using the Kidney Disease Improving Global Outcome (KDIGO) criteria. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 25.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of kidney impairment was 53.7%, with a significant increase in trend throughout the review. Acute Kidney Injury (AKI) was the most common type of KI with a prevalence of 53.2%. Eight out of ten patients with Chronic Kidney Disease (CKD) had a grade 5 CKD, and 1 out of 3 patients with AKI had a stage 3 AKI, with some requiring dialysis. Male gender (aor 4.01; 95% CI 2.13 – 7.76; p=0.01) and an increase in age (aOR 6.84; 95% CI 2.06 – 12.72; p=0.02) were significantly associated with Kidney impairment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAKI was the most common type of kidney impairment. One out of two patients admitted with a hypertensive emergency had kidney impairment. Kidney recovery was good in AKI, and the overall mortality was high. Our findings suggest the need for scaling up of early hypertension screening before the age of forty for early detection and control.\u003c/p\u003e","manuscriptTitle":"Type and severity of Kidney Impairment in patients admitted with a Hypertensive Emergency: a 5-year Retrospective Study ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-25 02:29:36","doi":"10.21203/rs.3.rs-5768615/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bdde4586-b788-4bf1-b4a5-37d90ab0e21e","owner":[],"postedDate":"June 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-15T08:54:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-25 02:29:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5768615","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5768615","identity":"rs-5768615","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}