Renin-angiotensin system blockers and the risk of COVID-19-related mortality in patients with kidney failure

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• dc.contributor.author Soler, María José
• dc.contributor.author Noordzij, Marlies
• dc.contributor.author Abramowicz, Daniel
• dc.contributor.author de Arriba, Gabriel
• dc.contributor.author Basile, Carlo
• dc.contributor.author van Buren, Marjolijn
• dc.contributor.author Covic, Adrian
• dc.contributor.author Crespo Barrio, Marta
• dc.contributor.author Duivenvoorden, Raphaël
• dc.contributor.author Massy, Ziad A.
• dc.contributor.author Ortiz, Alberto
• dc.contributor.author Sanchez, J. Emilio
• dc.contributor.author Petridou, Emily
• dc.contributor.author Stevens, Kate
• dc.contributor.author White, Colin
• dc.contributor.author Vart, Priya
• dc.contributor.author Gansevoort, Ron T.
• dc.contributor.author ERACODA Collaborators
• dc.date.accessioned 2022-06-30T06:20:32Z
• dc.date.issued 2021
• dc.description.abstract 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.
• dc.format.mimetype application/pdf
• dc.identifier.citation 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; ERACODA Collaborators. Renin-angiotensin system blockers and the risk of COVID-19-related mortality in patients with kidney failure. Clin J Am Soc Nephrol. 2021 Jul;16(7):1061-72. DOI: 10.2215/CJN.18961220
• dc.identifier.doi http://dx.doi.org/10.2215/CJN.18961220
• dc.identifier.issn 1555-9041
• dc.identifier.uri http://hdl.handle.net/10230/53642
• dc.language.iso eng
• dc.publisher American Society of Nephrology
• dc.relation.ispartof Clin J Am Soc Nephrol. 2021 Jul;16(7):1061-72
• dc.rights Copyright © 2021 by the American Society of Nephrology
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.subject.keyword COVID-19
• dc.subject.keyword Dialysis
• dc.subject.keyword Kidney failure
• dc.subject.keyword Kidney transplantation
• dc.subject.keyword Renin angiotensin system
• dc.title Renin-angiotensin system blockers and the risk of COVID-19-related mortality in patients with kidney failure
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/acceptedVersion