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

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...

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Autores: Soler, María José, Noordzij, Marlies, Abramowicz, Daniel, de Arriba, Gabriel, Basile, Carlo, van Buren, Marjolijn, Covic, Adrian, Crespo Barrio, Marta, Duivenvoorden, Raphaël, Massy, Ziad A., Ortiz, Alberto, Sanchez, J. Emilio, Petridou, Emily, Stevens, Kate, White, Colin, Vart, Priya, Gansevoort, Ron T., ERACODA Collaborators
Tipo de recurso: artículo
Estado:Versión aceptada para publicación
Fecha de publicación:2021
País:España
Institución:Universitat Pompeu Fabra
Repositorio:Repositorio Digital de la UPF
OAI Identifier:oai:repositori.upf.edu:10230/53642
Acceso en línea:http://hdl.handle.net/10230/53642
http://dx.doi.org/10.2215/CJN.18961220
Access Level:acceso abierto
Palabra clave:COVID-19
Dialysis
Kidney failure
Kidney transplantation
Renin angiotensin system
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spelling Renin-angiotensin system blockers and the risk of COVID-19-related mortality in patients with kidney failureSoler, María JoséNoordzij, MarliesAbramowicz, Danielde Arriba, GabrielBasile, Carlovan Buren, MarjolijnCovic, AdrianCrespo Barrio, MartaDuivenvoorden, RaphaëlMassy, Ziad A.Ortiz, AlbertoSanchez, J. EmilioPetridou, EmilyStevens, KateWhite, ColinVart, PriyaGansevoort, Ron T.ERACODA CollaboratorsCOVID-19DialysisKidney failureKidney transplantationRenin angiotensin systemBackground 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.American Society of Nephrology20222021info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/53642http://dx.doi.org/10.2215/CJN.18961220reponame:Repositorio Digital de la UPFinstname:Universitat Pompeu FabraInglésClin J Am Soc Nephrol. 2021 Jul;16(7):1061-72Copyright © 2021 by the American Society of Nephrologyinfo:eu-repo/semantics/openAccessoai:repositori.upf.edu:10230/536422026-06-12T07:21:37Z
dc.title.none.fl_str_mv Renin-angiotensin system blockers and the risk of COVID-19-related mortality in patients with kidney failure
title Renin-angiotensin system blockers and the risk of COVID-19-related mortality in patients with kidney failure
spellingShingle Renin-angiotensin system blockers and the risk of COVID-19-related mortality in patients with kidney failure
Soler, María José
COVID-19
Dialysis
Kidney failure
Kidney transplantation
Renin angiotensin system
title_short Renin-angiotensin system blockers and the risk of COVID-19-related mortality in patients with kidney failure
title_full Renin-angiotensin system blockers and the risk of COVID-19-related mortality in patients with kidney failure
title_fullStr Renin-angiotensin system blockers and the risk of COVID-19-related mortality in patients with kidney failure
title_full_unstemmed Renin-angiotensin system blockers and the risk of COVID-19-related mortality in patients with kidney failure
title_sort Renin-angiotensin system blockers and the risk of COVID-19-related mortality in patients with kidney failure
dc.creator.none.fl_str_mv Soler, María José
Noordzij, Marlies
Abramowicz, Daniel
de Arriba, Gabriel
Basile, Carlo
van Buren, Marjolijn
Covic, Adrian
Crespo Barrio, Marta
Duivenvoorden, Raphaël
Massy, Ziad A.
Ortiz, Alberto
Sanchez, J. Emilio
Petridou, Emily
Stevens, Kate
White, Colin
Vart, Priya
Gansevoort, Ron T.
ERACODA Collaborators
author Soler, María José
author_facet Soler, María José
Noordzij, Marlies
Abramowicz, Daniel
de Arriba, Gabriel
Basile, Carlo
van Buren, Marjolijn
Covic, Adrian
Crespo Barrio, Marta
Duivenvoorden, Raphaël
Massy, Ziad A.
Ortiz, Alberto
Sanchez, J. Emilio
Petridou, Emily
Stevens, Kate
White, Colin
Vart, Priya
Gansevoort, Ron T.
ERACODA Collaborators
author_role author
author2 Noordzij, Marlies
Abramowicz, Daniel
de Arriba, Gabriel
Basile, Carlo
van Buren, Marjolijn
Covic, Adrian
Crespo Barrio, Marta
Duivenvoorden, Raphaël
Massy, Ziad A.
Ortiz, Alberto
Sanchez, J. Emilio
Petridou, Emily
Stevens, Kate
White, Colin
Vart, Priya
Gansevoort, Ron T.
ERACODA Collaborators
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv COVID-19
Dialysis
Kidney failure
Kidney transplantation
Renin angiotensin system
topic COVID-19
Dialysis
Kidney failure
Kidney transplantation
Renin angiotensin system
description 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.
publishDate 2021
dc.date.none.fl_str_mv 2021
2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/acceptedVersion
format article
status_str acceptedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/53642
http://dx.doi.org/10.2215/CJN.18961220
url http://hdl.handle.net/10230/53642
http://dx.doi.org/10.2215/CJN.18961220
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Clin J Am Soc Nephrol. 2021 Jul;16(7):1061-72
dc.rights.none.fl_str_mv Copyright © 2021 by the American Society of Nephrology
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Copyright © 2021 by the American Society of Nephrology
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv American Society of Nephrology
publisher.none.fl_str_mv American Society of Nephrology
dc.source.none.fl_str_mv reponame:Repositorio Digital de la UPF
instname:Universitat Pompeu Fabra
instname_str Universitat Pompeu Fabra
reponame_str Repositorio Digital de la UPF
collection Repositorio Digital de la UPF
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.812429

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