Increased risk of acute kidney injury in coronavirus disease patients with renin\u2013angiotensin\u2013aldosterone-system blockade use: a systematic review and meta-analysis

Sul A Lee,Robin Park,Shin-Wook Kang,In Kyung Min,Jung Tak Park,Seung Hyeok Han,Tae-Hyun Yoo,Ji Hyun Yang

doi:10.1038/s41598-021-92323-8

Sul A Lee, Robin Park + Show 6 more

Open Access

https://doi.org/10.1038/s41598-021-92323-8

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Abstract

Acute kidney injury (AKI) is a severe complication of coronavirus disease (COVID-19) that negatively affects its outcome. Concern had been raised about the potential effect of renin–angiotensin–aldosterone system (RAAS) blockades on renal outcomes in COVID-19 patients. However, the association between RAAS blockade use and incident AKI in COVID-19 patients has not been fully understood. We investigated the association between RAAS blockade exposure and COVID-19-related AKI in hospitalized patients through meta-analysis. Electronic databases were searched up to 24th December 2020. Summary estimates of pooled odds ratio (OR) of COVID-19-related AKI depending on RAAS blockade exposure were obtained through random-effects model. The random-effect meta-analysis on fourteen studies (17,876 patients) showed that RAAS blockade use was significantly associated with increased risk of incident AKI in hospitalized COVID-19 patients (OR 1.68; 95% confidence interval 1.19–2.36). Additional analysis showed that the association of RAAS blockade use on COVID-19-related AKI remains significant even after stratification by drug class and AKI severity. RAAS blockade use is significantly associated with the incident AKI in hospitalized COVID-19 patients. Therefore, careful monitoring of renal complications is recommended for COVID-19 patients with recent RAAS blockade use due to the potential risk of AKI.

Highlights

Our study suggests that more careful clinical attention should be paid to COVID-19 patients with recent exposure to RAAS blockade due to their higher risk of AKI
Even though our meta-analysis showed a significant association between recent RAAS blockade use and the incidence of AKI in COVID-19 patients, the effect of RAAS blockade use on the outcome of AKI in COVID-19 patients remains unclear
Even though our study showed a significant association between RAAS blockade use and incident AKI in COVID-19 patients, this should be carefully interpreted

Summary

Methods

Published articles reporting incident AKI in COVID-19 patients and their use of ACEIs or ARBs from January 1, 2020 to December 24, 2020 were identified by searching PubMed, Embase, Cochrane, and Scopus. Studies were required to meet the following criteria: (1) case–control, retrospective or prospective cohort, or descriptive studies published in English; (2) human subjects with laboratory-confirmed or clinically diagnosed COVID-19; and (3) reported data on pharmacological RAAS blockade exposure either before or during hospitalization and the incidence of AKI. The author, type of study, location where the study was performed, date of publication, median/mean age, number of AKI cases, RAAS blockade use, definition of AKI, and diagnosis criteria of COVID-19 were extracted from each included study. Additional univariate meta-regression was performed to find potential covariates affecting the association between RAAS blockade use and COVID-19-related AKI which can be the source of high heterogeneity.

Results

Study design

Discussion