Evaluation of the relationship between acute kidney injury and renin angiotensin system inhibition in COVID-19 patients

OBJECTIVE: In patients with coronavirus disease 2019 (COVID-19), acute kidney injury (AKI) may alter the clinical course and outcome of the disease. In this study, the association of AKI with renin angiotensin system (RAS) inhibitor treatment and its clinical consequences were examined in COVID-19 patients admitted to our hospital during the initial stages of the pandemic.
METHODS: A total of 407 patients between 18 and 85 years of age (202 male and 205 female) admitted to the Umraniye Research And Training Hospital between May 2020 and August 2020 with a diagnosis of COVID-19 were included in the study. Patients were categorized as follows: Group 1, subjects with no chronic conditions (n=150); and Group 2, subjects with comorbid conditions (n=257). Group 2 was subdivided into Group 2A (receiving angiotensin receptor blocker [ARB])/(angiotensin converting enzyme inhibitor [ACEI], n=81), and Group 2B (not receiving ARB/ACEI, n=176).
RESULTS: Hypertension was the most frequent comorbid condition (36.4%). There was no difference in survival rates between the patients who used RAS inhibitor and the ones who did not based on log rank test (p=0.342). Fifty-four patients (13.4%) had developed AKI during the time frame of the disease. In patients with chronic diseases such as hypertension, the use of RAS inhibitory medication was not associated with developing AKI (OR 95% CI: 0.317–1.358; p=0.256). The survival rate of the patients with AKI was significantly lower than patients without AKI (p<0.0001).
CONCLUSION: COVID-19 may cause renal injury represents a risk factor for mortality. Therefore, detection of renal injury has a particular prognostic importance.

COVID-19 hastalarýnda akut böbrek hasarý ile renin anjiyotensin sistemi inhibisyonu arasýndaki iliþki deðerlendirilmesi

Giriþ: Koronavirüs enfeksiyonu (COVID 19) hastalarýnda akut böbrek hasarý (ABH) hastalýðýn klinik gidiþi ve sonuçlarýný deðiþtirebilmektedir. Bu çalýþmada pandeminin erken dönemlerinde hastanemize baþvuran Covid 19 hastalarýnda ABH geliþimi ve renin anjiotensin inhibitör (Ras inhibitörü) kullanýmý-nýn hastalýk klinik gidiþatý ile iliþkisini inceledik.
Yöntem: Çalýþmaya Mayýs 2020- Aðustos 2020 tarihleri arasýnda Ümraniye Eðitim ve Araþtýrma Hastanesine baþvuran Covid 19 tanýsý alan 18 ve 85 yaþ aralýðýnda toplam 407 hasta (202 erkek, 205 kadýn) dahil edilmiþtir. Hastalar kronik hastalýðý olmayan (n: 150) grup 1 ve komorbid hastalýðý olanlar olarak (n: 275) grup 2 olarak gruplandýrýlmýþtýr. Grup 2 anjiotensin konverting enzim inhibitörü (ACEi) /anjiotensin reseptör blokeri (ARB) kullanýmýna göre grup 2a (ACEi/ARB alan, n: 81) ve grup 2b (ACEi/ARB almayan, n: 176) ola-rak da ikiye ayrýlmýþtýr.
Bulgular: Hipertansiyon en sýk görülen komorbid hastalýk olarak tespit edildi (%36,4). Log rank testi-ne göre Ras inhibitörü kullanan hastalar ile kullanmayan hastalarýn yaþam oranlarýn arasýnda farklýlýk saptanmadý (p: 0.342). 54 hastada (%13.4) hastalýk sürecinde akut böbrek hasarý geliþmiþti. Hipertansi-yon gibi kronik hastalýðý olan hastalarda Ras inhibitörü kullanýmý ile akut böbrek hasarý geliþimi ile iliþki saptanmamýþtýr (OR %95 CI: 0.317; p: 0,256). ABH geliþen hastalarda saðkalým oraný ABH geliþ-meyen hastalara göre anlamlý derecede düþük saptanmýþtýr (p<0.0001).
Sonuç: Covid 19 mortalite açýsýndan bir risk faktörü de olan böbrek hasarýna neden olabilir. Bu yüz-den renal hasarýn tespiti özellikle prognostik bir önem taþýmaktadýr. (NCI-2022-7-12/R1)