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Effects of ACE inhibitor/ARB therapy and long COVID on kidney disease: a retrospective cohort study using real-world

Yue Zhang1, Djibril M Ba1, Kathryn Risher1

  • 1Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.

Clinical Kidney Journal
|July 26, 2024
PubMed
Abstract

Insights

Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) do not increase kidney disease risk in long COVID patients. However, long COVID itself is linked to higher risks of chronic kidney disease and mortality.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Pharmacology

Background:

  • Concerns exist regarding ACEI/ARB therapy and kidney disease risk in long COVID patients due to potential ACE-2 receptor upregulation.
  • This study investigates the impact of ACEI/ARB therapy on kidney outcomes and mortality in patients with and without long COVID.

Purpose of the Study:

  • To evaluate the association between ACEI/ARB use and the risk of acute kidney injury (AKI) and chronic kidney disease (CKD) in long COVID patients.
  • To assess the impact of ACEI/ARB therapy on all-cause mortality in patients with and without long COVID.

Main Methods:

  • Retrospective cohort study using TriNetX datasets with ICD-10 codes for long COVID diagnosis.
  • Four cohorts were established: long COVID ACEI/ARB users (LCAUs), long COVID non-users (LCANs), non-long COVID ACEI/ARB users (NLCAUs), and non-long COVID non-users (NLCANs).
  • Multivariable Cox proportional hazards regression models were used to assess adjusted hazard ratios (aHRs).

Main Results:

  • ACEI/ARB use did not significantly alter the risk of AKI or CKD in either long COVID or non-long COVID groups.
  • A protective effect against all-cause mortality was observed in NLCAUs compared to NLCANs (aHR 0.79).
  • Long COVID was associated with increased risks of CKD (aHR 1.49) and all-cause mortality (aHR 1.49) when comparing LCANs with NLCANs.

Conclusions:

  • ACEI/ARB treatment does not elevate the incidence of CKD or AKI, irrespective of long COVID status.
  • Long COVID independently increases the risk of kidney diseases and all-cause mortality.
  • The findings suggest that ACEI/ARB therapy is safe concerning kidney outcomes in long COVID patients.
Keywords:
acute kidney injuryangiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs)chronic kidney diseaselong COVIDreal-world analysis

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