Evaluation of the Relationship Between Acute Kidney Injury and Renin Angiotensin System Inhibition in COVID-19 Patients

Overview

Journal North Clin Istanb

Publisher Kare Publishing

Specialty General Medicine

Date 2023 Jan 23

PMID 36685627

Authors

Ezgi Ersoy Yesil

Hasan Kayabasi

Dede Sit

Mustafa Behcet Demirbas

Ozlem Pehlivan

Aylin Arslan

Tutku Aydin

Zeynep Gokcin

Affiliations

Soon will be listed here.

Abstract

Objective: In patients with coronavirus disease 2019 (COVID-19), acute kidney injury (AKI) may alter the clinical course and outcome of the disease. In this study, the association of AKI with renin angiotensin system (RAS) inhibitor treatment and its clinical consequences were examined in COVID-19 patients admitted to our hospital during the initial stages of the pandemic.

Methods: A total of 407 patients between 18 and 85 years of age (202 male and 205 female) admitted to the Umraniye Research And Training Hospital between May 2020 and August 2020 with a diagnosis of COVID-19 were included in the study. Patients were categorized as follows: Group 1, subjects with no chronic conditions (n=150); and Group 2, subjects with comorbid conditions (n=257). Group 2 was subdivided into Group 2A (receiving angiotensin receptor blocker [ARB])/(angiotensin converting enzyme inhibitor [ACEI], n=81), and Group 2B (not receiving ARB/ACEI, n=176).

Results: Hypertension was the most frequent comorbid condition (36.4%). There was no difference in survival rates between the patients who used RAS inhibitor and the ones who did not based on log rank test (p=0.342). Fifty-four patients (13.4%) had developed AKI during the time frame of the disease. In patients with chronic diseases such as hypertension, the use of RAS inhibitory medication was not associated with developing AKI (OR 95% CI: 0.317-1.358; p=0.256). The survival rate of the patients with AKI was significantly lower than patients without AKI (p<0.0001).

Conclusion: COVID-19 may cause renal injury represents a risk factor for mortality. Therefore, detection of renal injury has a particular prognostic importance.

References

Golmai P, Larsen C, DeVita M, Wahl S, Weins A, Rennke H . Histopathologic and Ultrastructural Findings in Postmortem Kidney Biopsy Material in 12 Patients with AKI and COVID-19. J Am Soc Nephrol. 2020; 31(9):1944-1947. PMC: 7461690. DOI: 10.1681/ASN.2020050683. View

Hansrivijit P, Gadhiya K, Gangireddy M, Goldman J . Risk Factors, Clinical Characteristics, and Prognosis of Acute Kidney Injury in Hospitalized COVID-19 Patients: A Retrospective Cohort Study. Medicines (Basel). 2021; 8(1). PMC: 7825666. DOI: 10.3390/medicines8010004. View

Tang N, Li D, Wang X, Sun Z . Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020; 18(4):844-847. PMC: 7166509. DOI: 10.1111/jth.14768. View

Fosbol E, Butt J, Ostergaard L, Andersson C, Selmer C, Kragholm K . Association of Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use With COVID-19 Diagnosis and Mortality. JAMA. 2020; 324(2):168-177. PMC: 7305566. DOI: 10.1001/jama.2020.11301. View

Rudiansyah M, Lubis L, Bandiara R, Supriyadi R, Afiatin , Gondodiputro R . Java Barb Fish Gallbladder-Induced Acute Kidney Injury and Ischemic Acute Hepatic Failure. Kidney Int Rep. 2020; 5(5):751-753. PMC: 7210697. DOI: 10.1016/j.ekir.2020.03.014. View

Su H, Yang M, Wan C, Yi L, Tang F, Zhu H . Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int. 2020; 98(1):219-227. PMC: 7194105. DOI: 10.1016/j.kint.2020.04.003. View

Levey A, Stevens L, Schmid C, Zhang Y, Castro 3rd A, Feldman H . A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150(9):604-12. PMC: 2763564. DOI: 10.7326/0003-4819-150-9-200905050-00006. View

Bean D, Kraljevic Z, Searle T, Bendayan R, Kevin O, Pickles A . Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are not associated with severe COVID-19 infection in a multi-site UK acute hospital trust. Eur J Heart Fail. 2020; 22(6):967-974. PMC: 7301045. DOI: 10.1002/ejhf.1924. View

Watkins J . Preventing a covid-19 pandemic. BMJ. 2020; 368:m810. DOI: 10.1136/bmj.m810. View

10.

Fang L, Karakiulakis G, Roth M . Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?. Lancet Respir Med. 2020; 8(4):e21. PMC: 7118626. DOI: 10.1016/S2213-2600(20)30116-8. View

11.

Martinez-Rojas M, Vega-Vega O, Bobadilla N . Is the kidney a target of SARS-CoV-2?. Am J Physiol Renal Physiol. 2020; 318(6):F1454-F1462. PMC: 7303722. DOI: 10.1152/ajprenal.00160.2020. View

12.

Zheng Y, Ma Y, Zhang J, Xie X . COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020; 17(5):259-260. PMC: 7095524. DOI: 10.1038/s41569-020-0360-5. View

13.

Santoriello D, Khairallah P, Bomback A, Xu K, Kudose S, Batal I . Postmortem Kidney Pathology Findings in Patients with COVID-19. J Am Soc Nephrol. 2020; 31(9):2158-2167. PMC: 7461662. DOI: 10.1681/ASN.2020050744. View

14.

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J . A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020; 382(8):727-733. PMC: 7092803. DOI: 10.1056/NEJMoa2001017. View

15.

Zhang G, Hu C, Luo L, Fang F, Chen Y, Li J . Clinical features and short-term outcomes of 221 patients with COVID-19 in Wuhan, China. J Clin Virol. 2020; 127:104364. PMC: 7194884. DOI: 10.1016/j.jcv.2020.104364. View

16.

Kudose S, Batal I, Santoriello D, Xu K, Barasch J, Peleg Y . Kidney Biopsy Findings in Patients with COVID-19. J Am Soc Nephrol. 2020; 31(9):1959-1968. PMC: 7461665. DOI: 10.1681/ASN.2020060802. View

17.

Thompson J, Meghani N, Powell B, Newell I, Craven R, Skilton G . Patient characteristics and predictors of mortality in 470 adults admitted to a district general hospital in England with Covid-19. Epidemiol Infect. 2020; 148:e285. PMC: 7729176. DOI: 10.1017/S0950268820002873. View

18.

Perico L, Benigni A, Remuzzi G . Should COVID-19 Concern Nephrologists? Why and to What Extent? The Emerging Impasse of Angiotensin Blockade. Nephron. 2020; 144(5):213-221. PMC: 7179544. DOI: 10.1159/000507305. View

19.

Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L . Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020; 97(5):829-838. PMC: 7110296. DOI: 10.1016/j.kint.2020.03.005. View

20.

Li X, Wang L, Yan S, Yang F, Xiang L, Zhu J . Clinical characteristics of 25 death cases with COVID-19: A retrospective review of medical records in a single medical center, Wuhan, China. Int J Infect Dis. 2020; 94:128-132. PMC: 7128884. DOI: 10.1016/j.ijid.2020.03.053. View