Post-nephrectomy outcomes in COVID-19 and non-COVID-19 Patients using ACEi, ARB and SGLT2i: a N3C database study

Nephrectomy can lead to hyperfiltration, focal segmental glomerulosclerosis (FSGS) and end-stage kidney disease (ESKD). We hypothesize that medications decreasing intraglomerular pressure have a positive impact on glomerular filtration among other outcomes after unilateral nephrectomy. The study investigated the possible impact of the SARS-CoV2 infection known as COVID-19 on outcomes among the unilateral nephrectomy recipients.

National Clinical Cohort Collaborative (N3C) database COVID19 Enclave was analyzed using multivariable linear regression and specific outcomes of eGFR values up to 3 years post-nephrectomy, occurrence of ESKD, HTN, FSGS, and gout.

In the non-COVID19 group, use of ACEi or ARB alone associated with a decrease in eGFR between 1 and 3 years (- 2.71 95% [- 3.90 to - 1.52]; p < 0.001), use of SGLT2i alone correlated with an increase (Coef 5.04 95% [0.781-9.301]; p = 0.02) while the concomitant use of ACEi or ARB with SGLT2i was not related to a variation in eGFR. These associations were not observed in the COVID19 group. COVID19 infection associated with an increased risk of post-nephrectomy ESKD development (HR 1.309 95% [1.066, 1.607]; p = 0.01), FSGS (HR 6.952 95% [2.685, 18.00]; p < 0.001) and gout (HR 1.411 95% [1.043, 1.907]; p = 0.025).

RAS blockade did not demonstrate any significant impact on the incidence of FSGS. The analysis was limited due to the absence of patients with both SGLT2i use and FSGS. SGLT2 inhibition correlated with an overall beneficial effect on the eGFR trend post-nephrectomy.