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Kidney Week

Abstract: FR-PO095

Association of Angiotensin-Converting Enzyme Inhibitor/Angiotensin Receptor Blocker Use with Kidney Diseases Among Long-COVID and Non-Long-COVID Adults: Retrospective Cohort Study of Real-World Data

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Zhang, Yue, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Ba, Djibril, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Ghahramani, Nasrollah, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Chinchilli, Vernon M., Penn State College of Medicine, Hershey, Pennsylvania, United States
Background

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are widely prescribed for hypertension. In vitro studies have suggested that ACEIs/ARBs upregulate ACE-2 expression, the receptor for SARS-CoV-2 entry, particularly in kidneys. It was hypothesized that the risk of kidney diseases may be elevated in individuals with Long COVID receiving ACEI/ARB therapy. The objective of this research is to examine the relationship between ACEI/ARB usage and the occurrence of acute kidney injury (AKI) in both Long COVID and non-Long COVID populations.

Methods

A retrospective cohort study using TriNetX datasets was conducted, with diagnoses of long COVID and kidney outcomes identified via International Classification of Diseases 10th revision (ICD-10) codes. Four cohorts were built: long COVID ACEI/ARB users (LCAU), long COVID non-users (LCAN), non-long COVID ACEI/ARB users (NLCAU), and non-long COVID ACEI/ARB non-users (NLCAN). Multivariable stratified Cox proportional hazards regression models were used to analyze the relationships. Meanwhile, we also compared the hazard ratio of AKI, CKD, and MAKE between ACEI/ARB and an active comparator, calcium channel blockers (CCB).

Results

A total of 164,070 qualified participants were included from 10/01/2021 to 02/14/2023, with 10,627 long COVID patients and 12,574 ACEI/ARB users. After controlling for demographics, drug histories, and comorbidities, ACEI/ARB use did not significantly impact the risk of AKI, CKD, and MAKE, when comparing LCAU to LCAN, and NLCAU to NLCAN. However, an increased AKI risk was associated with long COVID when comparing LCAN to NLCAN (aHR, 1.61; 95% CI, 1.27 – 2.06). No significant difference in HR of each kidney outcome between ACEI/ARB and CCB was found in both long COVID and non-long COVID cohorts.

Conclusion

ACEI/ARB use does not appear to elevate the incidence of AKI in comparison to non-users and active comparators for both Long COVID and non-Long COVID participants. Instead, it is Long COVID that has been associated with an increased risk of AKI.