Long-term ACE Inhibitor/ARB Use Is Associated With Severe Renal Dysfunction and Acute Kidney Injury in Patients With Severe COVID-19: Results From a Referral Center Cohort in the Northeast of France. (5th July 2020)

• Record Type: Journal Article
• Authors: Oussalah, Abderrahim; Gleye, Stanislas; Clerc Urmes, Isabelle; Laugel, Elodie; Callet, Jonas; Barbé, Françoise; Orlowski, Sophie; Malaplate, Catherine; Aimone-Gastin, Isabelle; Caillierez, Beatrice Maatem; Merten, Marc; Jeannesson, Elise; Kormann, Raphaël; Olivier, Jean-Luc; Rodriguez-Guéant, Rosa-Maria; Namour, Farès; Bevilacqua, Sybille; Losser, Marie-Reine; Levy, Bruno; Kimmoun, Antoine; Gibot, Sébastien; Thilly, Nathalie; Frimat, Luc; Schvoerer, Evelyne; Guéant, Jean-Louis
• Is Part Of: Clinical infectious diseases. Volume 71:Number 9(2020)
• Page Start: 2447
• Page End: 2456
• Publication Date: 2020-07-05
• Subjects: SARS-CoV-2 -- severe COVID-19 -- angiotensin-converting enzyme inhibitor -- angiotensin receptor blocker -- acute kidney injury; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciaa677
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: In patients with severe coronavirus disease 2019 (COVID-19), data are scarce and conflicting regarding whether chronic use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) influences disease outcomes. In patients with severe COVID-19, we assessed the association between chronic ACEI/ARB use and the occurrence of kidney, lung, heart, and liver dysfunctions and the severity of the inflammatory reaction as evaluated by biomarkers kinetics, and their association with disease outcomes. Methods: We performed a retrospective longitudinal cohort study on consecutive patients with newly diagnosed severe COVID-19. Independent predictors were assessed through receiver operating characteristic analysis, time-series analysis, logistic regression analysis, and multilevel modeling for repeated measures. Results: On the 149 patients included in the study 30% (44/149) were treated with ACEI/ARB. ACEI/ARB use was independently associated with the following biochemical variations: phosphorus >40 mg/L (odds ratio [OR], 3.35, 95% confidence interval [CI], 1.83–6.14), creatinine >10.1 mg/L (OR, 3.22, 2.28–4.54), and urea nitrogen (UN) >0.52 g/L (OR, 2.65, 95% CI, 1.89–3.73). ACEI/ARB use was independently associated with acute kidney injury stage ≥1 (OR, 3.28, 95% CI, 2.17–4.94). The daily dose of ACEI/ARB was independently associated with altered kidney markers with an increased risk of +25 to +31% per each 10 mg increment of lisinopril-dose equivalent. In multivariable multilevel modeling, UN >0.52 g/L was independently associated with the risk of acute respiratory failure (OR, 3.54, 95% CI, 1.05–11.96). Conclusions: Patients chronically treated with ACEI/ARB who have severe COVID-19 are at increased risk of acute kidney injury. In these patients, the increase in UN associated with ACEI/ARB use could predict the development of acute respiratory failure. Abstract : The present retrospective longitudinal cohort study on consecutive patients with newly diagnosed severe COVID-19 provides new evidence on the potentially harmful effect of chronic ACEI/ARB use on kidney outcomes and their possible interaction with the occurrence of acute respiratory failure.