Abstract Body: Introduction
Chronic kidney disease (CKD) is characterized by progressive decline in renal function. This renal deterioration may be accelerated by hypertension which is both a common cause and complication of CKD. Hypertensive crises in this population of patients carry elevated risks of further neurologic, cardiovascular, and renal impairment. Although there is an established association with CKD and adverse cardiovascular outcomes, there is limited data on in-hospital clinical outcomes in patients with CKD presenting with hypertensive crises. This study aimed to investigate these outcomes.

Methods
Patients admitted with the primary diagnosis of hypertensive crisis were identified using the 2021 National Inpatient Sample (NIS) and stratified based on the presence of CKD. Logistic and linear regression models were used to study the relationship between outcomes in patients with a history of CKD who were hospitalized for hypertensive crisis, adjusting for confounding variables using the Charlson comorbidity index. A univariate screen with a p-value cutoff of less than 0.2 was performed followed by a multivariate analysis. The threshold for statistical significance was set at a 2-tailed p-value of 0.05.

Results
In the group of patients admitted with a primary diagnosis of hypertensive emergency and concurrent diagnosis of CKD, there was increased age-related mortality. Each one-year increase in age was associated with a 4.3% increase in mortality (aOR 1.04, 95% CI 1.02-1.07). There were also significantly increased odds of renal replacement therapy (aOR 212, 95% CI 117.45-384.86). Females in the study group had lower odds of mechanical ventilation (aOR 0.70, 95% CI 0.51-0.944) and total hospital charges (aOR -1451.22, 95% CI -2638.19- -264.26). Patients with Medicaid insurance had higher length of stays compared to private insurance (aOR 0.23, 95% CI 0.10-0.37).

Conclusion
Out study highlighted that there is an increased age-related mortality in patients with CKD that present to the hospital in hypertensive crises. Interestingly, females in the study group had lower hospital charges and odds of mechanical ventilation, which may be consistent with sex-based differences in cardiovascular and renal pathophysiology that can lead to more favorable outcomes. Additionally, clinicians need to be aware of socioeconomic disparities including insurance status to ensure that all patients receive equitable care.