Renin-angiotensin-aldosterone system blockers in Bulgarian COVID-19 patients with or without chronic kidney disease.

Autor:	Filev R; Department of Nephrology, Internal disease Clinic, University Hospital 'Saint Anna,' Sofia, Bulgaria.; Medical University Sofia, Bulgaria., Rostaing L; Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, Grenoble, France.; Grenoble Alpes University, Grenoble, France., Lyubomirova M; Department of Nephrology, Internal disease Clinic, University Hospital 'Saint Anna,' Sofia, Bulgaria.; Medical University Sofia, Bulgaria., Bogov B; Department of Nephrology, Internal disease Clinic, University Hospital 'Saint Anna,' Sofia, Bulgaria.; Medical University Sofia, Bulgaria., Kalinov K; Head Biometrics Group, Comac-Medical Ltd, Sofia, Bulgaria., Svinarov D; Medical University Sofia, Bulgaria.; Department of Clinical Laboratory, University Hospital 'Alexandrovska,' Sofia, Bulgaria.
Jazyk:	angličtina
Zdroj:	Medicine [Medicine (Baltimore)] 2022 Dec 02; Vol. 101 (48), pp. e31988.
DOI:	10.1097/MD.0000000000031988
Abstrakt:	When angiotensin-converting enzyme inhibitor/angiotensin receptor blocker-treated patients present with SARS-CoV-2 infection there is a debate to know whether renin-angiotensin-aldosterone (RAAS) blockers should be stopped or not. We conducted a prospective observational study in Bulgarian COVID-19-infected patients with or without chronic kidney disease (CKD) to assess whether maintenance RAAS blocker therapy has an impact on SARS-CoV-2 infection and its complications. We included 120 in-patient COVID-19 subjects, of whom 70 had CKD and 50 had normal renal function. A total of 30% of the patients (total number of 36 patients, 21 females) were receiving RAAS therapy at admission and it was maintained throughout hospitalization. The overall mortality was 19.2% (23 patients); there was no significant difference across the 2 groups (P-value = .21), except in RAAS blockers-treated hypertensive patients who had a significantly lower mortality as compared to non-RAAS-blockers-treated hypertensive patients (P = .04). Regarding subsequent intensive-care unit admission, there were 50% less patients in the RAAS group (4 out of 36, i.e., 11%) as compared to 19 out of 84 from the non-RAAS group, that is, 22.6% (P = .29). Overall, 37 patients developed acute kidney injury (any stage by KDIGO); of them 14 (37.8%) were receiving RAAS blockers. Acute kidney injury was not significantly associated with the use of RAAS blockers (P-value = .28). Likewise, both in non-CKD and in CKD patients the use of RAAS blockers did not have an impact on renal function recovery after SARS-CoV-2 infection. Finally, regarding RAAS blockers and the biological parameters outcome only D-dimers were significantly lower at the follow-up as compared to that in non-RAAS blocker treated patients. RAAS blockers benefited patients with hypertension by lowering mortality rate. Other than that, RAAS blocker therapy continuation during SARS-CoV-2 infection in CKD and non-CKD patients had no significant impact upon major outcomes. Competing Interests: The authors have no funding and conflicts of interest to disclose. (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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