Abstract: PO0846
The Use of ACE Inhibitors and ARBs in Patients Admitted for COVID-19
Session Information
- COVID-19: Clinical and Basic Science Characteristics
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Me, Hay Me, Westchester Medical Center, Valhalla, New York, United States
- Sen, Aditi A., Westchester Medical Center, Valhalla, New York, United States
- Zheng, Zhong, Westchester Medical Center, Valhalla, New York, United States
- Griffiths, Jennifer, Westchester Medical Center, Valhalla, New York, United States
- Becerra rivera, Viviam Isleny, Westchester Medical Center, Valhalla, New York, United States
- Gupta, Sanjeev, Westchester Medical Center, Valhalla, New York, United States
- Chugh, Savneek S., Westchester Medical Center, Valhalla, New York, United States
- Kore, Shruti, Westchester Medical Center, Valhalla, New York, United States
- Mangaroliya, Vrunda, Westchester Medical Center, Valhalla, New York, United States
- Bustos, Aulio Elias, Westchester Medical Center, Valhalla, New York, United States
Background
Angiotensin converting enzyme (ACE 2) receptor has been implicated as an entry point for severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) causing pandemic coronavirus disease 2019 (COVID-19). Experts have postulated the potential benefits of using ACEI/ARB to reduce the severity of acute lung injury and as the treatment of hypertension in COVID-19. However, there is limited data in showing the renal outcomes after the use of angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in COVID-19 patients.
Methods
This is a retrospective, single center study of 300 patients diagnosed with COVID-19 confirmed by real-time reverse transcription polymerase chain reaction. Four groups were divided based on ACEI/ARB exposure. Group 1 (n=51 patients; 17%) were initiated on ACEIs/ARBs during hospitalization, group 2 (n=58 patients; 19%) were on ACEIs/ARBS at home and discontinued, group 3 (n=76 patients; 25%) were on ACES/ARBS at home and continued during hospitalization and group 4 (n=116 patients; 38%) were never treated with ACEIs/ARBS. The primary end points including the incidence of AKI using KDIGO definition, hyperkalemia, the necessity of dialysis and the secondary end points being the length of total hospital stays, the recovery rate, mortality rate were compared between group 1,2,3 with 4 using adjusted odd ratios (ORs).
Results
In group 1, the use of ACEI/ARB has 4 times higher risk of developing AKI than the control group 4 (P= 0.001, 95% CI of 1.70-9.59). and is 4.6 times for stage 2 or above AKI (P= 0.001; 95% CI of 1.8-11.5). OR for hyperkalemia is 5.7 (P= 0.001, 95% CI of 2.09-15.5) and for hemodialysis is 3.7 (P= 0.02, 95% CI of 1.2-11.2). Their mortality rate is increased 2.9 times (P=0.026, 95% CI of 1.23-7.44). In group 2, the incidence of AKI is 7.5 times higher (P= <0.001, 95% CI of 3.3-17) and 3.5 times (P=0.001, 95% CI of 1.6-7.7) for stage 2 above AKI. OR for the initiation of hemodialysis and the mortality rate are not statistically significant after adjusted with variables. In group 3, no statistically significant data were found.
Conclusion
Our findings suggest that the initiation of ACEI/ARB in COVID 19 patients have increased risk of AKI, hyperkalemia, necessity of dialysis and mortality rate.