Risk of COVID-19 among Patients Treated with RAAS Inhibitors

Researchers have hypothesized that direct viral invasion of the kidney via angiotensin converting enzyme is a mechanism of acute kidney injury (AKI) in patients with COVID-19. There are few data available on the impact of renin-angiotensin-aldosterone system inhibitors (RAASi) on the risk of AKI in COVID-19.

Bethany Birkelo, DO, and colleagues conducted a retrospective cohort study to test the hypothesis that active use of RAASi prior to admission would be associated with a greater proportional risk of AKI in COVID-19 compared with influenza. The study compared the incidence of AKI by RAASi status in 11,898 hospitalized veterans with COVID-19 or influenza between October 2, 2019, and September 30, 2020. Results were reported during a virtual poster session at ASN Kidney Week 2012 in a poster titled RAAS Inhibition and Risk of AKI in COVID-19.

Propensity score weighting balanced baseline conditions, laboratory results, and co-therapies in four exposure groups controlled for confounders. The four groups were RAASi users with COVID-19, non-users with COVID-19, RAASi users with influenza, and non-users with influenza. Weighted logistic regression was used to estimate the main effects of RAASi and COVID-19, and their interaction.

In the influenza groups, 7% of RAASi users had stage 2-3 AKI compared with 5% of non-users, a 2% increase (P=.03). In the COVID-19 groups, 16% of RAASi users had stage 2-3 AKI versus 12% of non-users, a 4% increase. The absolute increase in incidence of AKI for RAASi users versus non-users was greater among patients with COVID-19 than in patients with influenza; however, the difference was not statistically significant (P=.66) and the RAASi association was proportionally smaller in COVID-19. Similar absolute differences were seen in stage 1-3 AKI; that interaction was also not statistically significant (P=.66).

In summary, the authors said, “COVID-19 was associated with a greater incidence of AKI than influenza. RAASi was associated with an increased incidence of stage 2-3 AKI in patients with COVID-19 or influenza. The proportional effect of RAASi was similar in COVID-19 and influenza patients, These findings do not support a disproportionate risk of AKI among RAASi users with COVID-19.”

Source: Birkelo B, Perkins A, Greevy R, et al. RAAS Inhibition and Risk of AKI in COVID-19. Abstract of a poster presented at the American Society of Nephrology virtual Kidney Week 2021 (Abstract PO0037), November 2021.