S3306 H2-Blocker Use Is Associated With Acute Kidney Injury Among COVID-19 Patients

Abstract

INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) has infected over 6.5 million people worldwide, claiming nearly 400,000 lives as of June 2020. Among those hospitalized, acute kidney injury (AKI) occurs in approximately 20–40% of patients. Proton pump inhibitors (PPIs) and H2-blockers (H2Bs) are commonly used medications and have been linked to acute and chronic interstitial nephritis. We assessed the association between PPI or H2B use prior to admission and AKI among patients admitted with COVID-19 infections. METHODS: This was a single center retrospective cohort study. Adult patients with confirmed COVID-19 infection admitted from March to April 2020 were identified. Patients with end-stage renal disease were excluded. Charts were reviewed for patient demographics, outpatient medication list, creatinine at baseline and upon admission, and hospital course. The primary outcome was any association between PPI or H2B use with development of AKI. RESULTS: We reviewed 100 consecutive patients admitted with COVID-19 and 93 patients were included. The mean age of this cohort was 58.9 years and 36.5% were female (Table 1). Sixteen patients were prescribed a PPI prior to admission and 6 patients were on H2B. Of the 93 patients, 84 did not have known chronic kidney disease (CKD). Among patients without CKD, PPI use was not associated with AKI (P = 0.857) but patients taking H2Bs were more likely to develop AKI on admission (P = 0.032) (Figure 1). There were no differences in average BUN-to-creatinine ratios (P = 0.172) or rates of systemic inflammatory response syndrome (P = 0.904) between those who were on H2Bs versus those who were not. CONCLUSION: Among non-CKD patients who were admitted for COVID-19 infection, H2B use was associated with development of AKI whereas PPI use was not. In vitro studies have shown cimetidine to raise serum creatinine theoretically by competitive tubular secretion for creatinine. In the setting of COVID-19 infection and systemic inflammation, reduced renal blood flow adds insult to the kidneys and may synergistically raise serum creatinine with famotidine use. Increased awareness of the relationship between medications and COVID-19 infection may be helpful in providing comprehensive care for critically ill patients.Table 1.: Demographics and clinical characteristicsFigure 1.: Incidence of acute kidney injury (AKI) on admission among patients without chronic kidney disease (CKD).