TREATMENT WITH BLOCKERS OF THE RENIN-ANGIOTENSIN SYSTEM DOES NOT AFFECT RENAL FUNCTION IN PATIENTS WITH SEVERE COVID-19 ADMITTED TO INTENSIVE CARE UNIT

Abstract

Objective: Patients with severe COVID-19 admitted to Intensive Care Units (ICU) are often challenging because of the complications related to co-existing diseases. Among these hypertension is highly prevalent and blockers of renin-angiotensin system (RAS-B) are frequently reported as home drug therapy. However the influence of these medications on renal function and mortality is matter of debate. Design and method: We retrospectively analyzed clinical data and drug treatment of 90 patients (F/M 25/65) admitted in our ICU for severe COVID-19, with lung disease severity expressed as pO2/fractional inspired oxygen (P/F) below 300 mmHg. In normotensive (n = 35) and hypertensive patients previously treated with (n = 35) or without (n = 20) RAS-B, we compared systolic and diastolic blood pressure (SBP and DBP, mmHg), serum creatinine (SC, mg/dl) and potassium (SK, mEq/L) baseline and SC peak values reached during the admission in ICU. Rate of renal replacement therapy (RRT) and mortality were also recorded. Results: Baseline mean SBP and DBP were within the normal limits and similar in normotensive and in both groups of hypertensive patients while P/F was 157 ± 71 in normotensives and 137 ± 64 vs. 94 ± 30 respectively in hypertensives with and without RAS-B. In the latter two groups, baseline, SC and SK were similar (respectively 1 ± 0.5 vs. 1 ± 0.8 and 4 ± 0.6 vs. 4 ± 0.6) and peak SC values were similar as well (respectively 1.74 ± 1.3 vs. 1.71 ± 1.7). Among the seven patients who needed RRT three and four respectively were on and off treatment with RAS-B. Overall mortality was slightly but not significantly higher in hypertensive than in normotensive patients (31/55, 56% and 15/35, 43%) but similar in those with and without RAS-B (19/35, 54% and 12/20, 60%). Conclusions: These preliminary data suggest that in patients with severe COVID-19 admitted to ICU, the use of RAS blockers for the treatment of hypertension prior to the infection does not affect renal function, the need of RRT and mortality.