Renin-angiotensin-aldosterone system (RAASi) inhibitor drugs, which are commonly used to regulate high blood pressure, do not disproportionately increase the risk of acute kidney injury (AKI) in patients with COVID-19 compared to patients hospitalized with influenza, VUMC researchers reported recently in the Clinical Journal of the American Society of Nephrology.
AKI is a common complication in patients who are hospitalized for COVID-19.
One possible cause of AKI in COVID-19 is direct infection of kidney epithelium by the virus itself, a process mediated through angiotensin-converting enzyme II (ACE2) protein, which is expressed in multiple organs including the kidney. Medications that affect the renin-angiotensin-aldosterone system may increase the amount of ACE2 protein in the kidney.
Prior to this research the effect of RAASi drug use on AKI in COVID-19 patients was unknown. The VUMC research team, which included Edward Siew, MD, associate professor of Medicine and senior author on the paper; Michael Matheny, MD, associate professor of Biomedical Informatics; Bethany Birkelo, DO, clinical fellow of Nephrology; and Robert Greevy, PhD, associate professor of Biostatistics, set out to determine if RAASi use carried a unique risk of AKI in patients with COVID-19 compared to another severe respiratory viral illness.
They compared the risk of AKI by RAASi status among 27,189 veterans hospitalized with either COVID-19 or influenza between Oct. 1, 2019, and Feb. 28, 2021. Among RAASi nonusers, 1,908 hospitalizations were for influenza and 15,028 hospitalizations for COVID-19. Among RAASi users, 1,276 hospitalizations were for influenza and 8,977 hospitalizations for COVID-19.
AKI was more common among patients with COVID-19 versus influenza, at 30% versus 26%. While the incidence of AKI was greater in RAASi users compared with nonusers in both the influenza and COVID-19 groups, the association of RAASi use and AKI was not proportionally different between the COVID-19 and influenza groups.
“The similar increase in risk associated with RAASi use in both illnesses suggests that RAASi use does not carry a unique risk of AKI in patients with COVID-19,” said Siew. “However, these findings also underscore the importance of carefully considering an individual’s AKI risk factors when weighing the risk and benefits of RAASi use in hospitalized patients infected with COVID-19.”
This work was supported by the Veterans Affairs HSR&D grants COVID-19 Rapid Response Project C19 20-214 and T32DK007569-32; by the Million Veteran Program grant SDR 18-194; and the Vanderbilt O’Brien Kidney Center P30-DK114809 Clinical and Translational Research Core.
