The use of ace inhibitors and ARBS in patients admitted for COVID-19

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 Conclusions: 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