Clin J Am Soc Nephrol. 2021 Jun 4:CJN.18961220. doi: 10.2215/CJN.18961220. Online ahead of print.
Background: There is concern about potential deleterious effects of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) in patients with COVID-19. Patients with kidney failure, who often use ACEi/ARB, are at higher risk of more severe COVID-19. However, there are no data available on the association of ACEi/ARB use with COVID-19 severity in this population. Methods: Data were retrieved from the ERACODA database of kidney transplant and dialysis patients affected by COVID-19, between February 1 and October 1 2020, and had information on 28-day mortality. Cox proportional-hazards regression was used to calculate hazard ratios (HRs) for the relation between ACEi/ARB use and 28-day mortality risk. Additionally, we studied the association of ACEi/ARB discontinuation with 28-day mortality. Results: We evaluated 1,511 patients, 459 kidney transplant recipients and 1,052 dialysis patients. At COVID-19 diagnosis, 189 (41%) of the transplant and 288 (27%) of the dialysis patients were on ACEi/ARB. In transplant, 88 (19%) and in dialysis patients 244 (23%) died within 28 days of initial presentation. In transplant and dialysis patients, there was no association between ACEi/ARB use and 28-day mortality in both crude and adjusted models (adjusted HR=1.12, 95%CI: 0.69-1.83 in transplant; 1.04, 95%CI: 0.73-1.47 in dialysis patients). Among transplant recipients, ACEi/ARB discontinuation was associated with higher mortality risk after adjustment for demographics and comorbidities, but the association was no longer statistically significant after adjustment for COVID-19 severity (adjusted HR=1.36, 95%CI: 0.40-4.58). Among dialysis patients, ACEi/ARB discontinuation was not associated with mortality in any model. Similar results were obtained across subgroups when ACEi and ARB were studied separately and when other outcomes for COVID-19 severity were studied e.g., hospital admission, intensive care unit admission or need for ventilator support. Conclusions: Amongst kidney transplant and dialysis patients with COVID-19, there was no significant association of ACEi/ARB use or ACEi/ARB discontinuation with mortality.