Renin-Angiotensin System Blockers and the Risk of COVID-19-Related Mortality in Patients with Kidney Failure
Por:
Soler, MJ, Noordzij, M, Abramowicz, D, de Arriba, G, Basile, C, van Buren, M, Covic, A, Crespo, M, Duivenvoorden, R, Massy, ZA, Ortiz, A, Sanchez, JE, Petridou, E, Stevens, K, White, C, Vart, P, Gansevoort, RT, Canal C., Facundo C., ERACODA Collaborators
Publicada:
1 jul 2021
Resumen:
Background and objectives There is concern about potential deleterious effects of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin II receptor blockers (ARBs) in patients with coronavirus disease 2019 (COVID-19). Patients with kidney failure, who often use ACEis/ARBs, are at higher risk of more severe COVID-19. However, there are no data available on the association of ACEi/ARB use with COVID-19 severity in this population.
Design, setting, participants, & measurements From the European Renal Association COVID-19 database (ERACODA), we retrieved data on kidney transplant recipients and patients on dialysis who were affected by COVID-19, between February 1 and October 1, 2020, and had information on 28-day mortality. We used Cox proportional-hazards regression to calculate hazard ratios for the association between ACEi/ ARB use and 28-day mortality risk. Additionally, we studied the association of discontinuation of these agents with 28-day mortality.
Results We evaluated 1511 patients: 459 kidney transplant recipients and 1052 patients on dialysis. At diagnosis of COVID-19, 189 (41%) of the transplant recipients and 288 (27%) of the patients on dialysis were on ACEis/ ARBs. A total of 88 (19%) transplant recipients and 244 (23%) patients on dialysis died within 28 days of initial presentation. In both groups of patients, there was no association between ACEi/ ARB use and 28-day mortality in both crude and adjusted models (in transplant recipients, adjusted hazard ratio, 1.12; 95% confidence interval [95% CI], 0.69 to 1.83; in patients on dialysis, adjusted hazard ratio, 1.04; 95% CI, 0.73 to 1.47). Among transplant recipients, ACEi/ARB discontinuation was associated with a higher mortality risk after adjustment for demographics and comorbidities, but the association was no longer statistically significant after adjustment for severity of COVID-19 (adjusted hazard ratio, 1.36; 95% CI, 0.40 to 4.58). Among patients on dialysis, ACEi/ARB discontinuation was not associated with mortality in any model. We obtained similar results across subgroups when ACEis and ARBs were studied separately, and when other outcomes for severity of COVID-19 were studied, e.g., hospital admission, admission to the intensive care unit, or need for ventilator support.
Conclusions Among kidney transplant recipients and patients on dialysis with COVID-19, there was no significant association of ACEi/ ARB use or discontinuation with mortality.
Filiaciones:
Soler, MJ:
Vall dHebron Univ Hosp, Dept Nephrol, Vall dHebron Inst Res, Red Invest Renal REDINREN, Vall dHebron Barcelona Hosp Campus, Barcelona, Spain
Noordzij, M:
Univ Groningen, Univ Med Ctr Groningen, Dept Internal Med, Groningen, Netherlands
Abramowicz, D:
Antwerp Univ Hosp, Dept Nephrol, Edegem, Belgium
Univ Antwerp, Lab Expt Med & Pediat, Antwerp, Belgium
de Arriba, G:
Univ Alcala, Univ Hosp Guadalajara, Dept Nephrol, Guadalajara, Spain
Basile, C:
Miulli Gen Hosp, Div Nephrol, Acquaviva Delle Fonti, Italy
van Buren, M:
Leiden Univ, Univ Med Ctr Leiden, Dept Nephrol, Leiden, Netherlands
Haga Hosp, Dept Internal Med, The Hague, Netherlands
Covic, A:
Grigore T Popa Univ Med & Pharm, Dr CI Parhon Hosp, Iasi, Romania
Crespo, M:
Hosp del Mar, Dept Nephrol, Mar Inst Med Res, Red Invest Renal REDINREN, RD16-0009-0013, Barcelona, Spain
Duivenvoorden, R:
Radboud Univ Nijmegen, Dept Nephrol, Med Ctr, Nijmegen, Netherlands
Massy, ZA:
Ctr Hosp Univ CHU Ambroise Pare, AP HP, Dept Nephrol, Boulogne, France
Univ Paris Saclay, Univ Versailles St Quentin, Ctr Res Epidemiol & Populat Hlth CESP, Inst Natl Sante & Rech Med INSERM,UMRS 1018, Team 5, Villejuif, France
Ortiz, A:
Autonomous Univ Madrid UAM, Fdn Jimenez Diaz, Inst Invest Sanitaria IIS, Red Invest Renal REDINREN, Madrid, Spain
Sanchez, JE:
Univ Hosp Cabuenes, Asturias, Spain
Petridou, E:
Representat European Kidney Patients Federat, Nicosia, Cyprus
Stevens, K:
Queen Elizabeth Univ Hosp, Glasgow Renal & Transplant Unit, Glasgow, Lanark, Scotland
White, C:
Representat European Kidney Patients Federat, Dublin, Ireland
Vart, P:
Univ Groningen, Univ Med Ctr Groningen, Dept Internal Med, Groningen, Netherlands
Univ Groningen, Univ Med Ctr Groningen, Dept Clin Pharm & Pharmacol, Groningen, Netherlands
Gansevoort, RT:
Univ Groningen, Univ Med Ctr Groningen, Dept Internal Med, Groningen, Netherlands
Canal C.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Facundo C.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Green Published, Bronze
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