Abstract 15615: The Association of Acute Kidney Injury With Angiotensin Converting Enzyme Inhibitor and Angiotensin Ii Receptor Blockers Use in Patients With Sars-cov-2

Abstract

Introduction: Previous studies have suggested that SARS-CoV-2 causes microvascular inflammation and thrombosis, leading to microvascular angiopathy. A downstream sequela of microvascular angiopathy is AKI. Literature extensively describes the renoprotective effects of ACEI and ARB. Hypothesis: We hypothesize that using an ACEI/ARB in patients with SARS-CoV-2 is negatively associated with AKI. Methods: We conducted a retrospective chart review of patients 18 years and older who tested positive for SARS- CoV-2 using a polymerase chain reaction test between March 2020 and April 2021. Patients were divided into two groups, AKI, and non-AKI. The primary outcomes were all-cause mortality and hospitalization rate. The secondary outcomes were myocardial infarction, hypotension, intubation, use of vasopressors and ventricular tachycardia (VT). We used multivariate logistic regression to adjust for baseline characteristics. Results: We identified a total of 1,212 patients with AKI and 21,887 without AKI who tested positive for SARS-CoV-2. Incidence was 539 (44%) for all-cause mortality, 1144 (94.2%) for hospitalization, and 413 (34.6%) for patients taking ACEI/ARB. After logistic regression analysis, OR was 3.006 (95% Confidence Interval [CI]: 2.342-3.858; p<0.001) for hospitalization, 7.359 (95% CI:5.191-10.433, p <0.001) for all-cause mortality, and 1.034 (95% CI: 0.784-1.365; p< 0.810) for patients taking ACEI/ARB. The AKI group had significantly increased adjusted OR for hypotension (p< 0.001), calcium channel (p<0.001) and beta-blocker (p<0.038) use. Adjusted OR for all other secondary outcomes were not increased but not significant, including myocardial infarction (p<0.697), VT (p<0.184), vasopressor use (p<0.113), and intubation (p<0.096). Conclusions: This study suggests that ACEI/ARB use was not positively associated with AKI in patients with SARS-CoV-2, while calcium channel blocker and beta-blocker use were. A positive association between BB and CCB with AKI suggests that there should be a preference for ACEI/ARB in patients where all three medications are possible therapy options. Further studies are needed to confirm the association between ACE/ARB and AKI and rule out potential confounding variables.