Association of prehospital RAAS inhibitor use with AKI and death in a cohort of hospitalized COVID-19-infected patients

Background: The relationship of RAAS inhibitors (RAASi) and their purported role in increasing COVID-19 viral attachment and worse outcomes is controversial In this study we examined the association of RAASi use with Acute Kidney Injury (AKI) and in-hospital death Methods: We assembled a cohort of all patients admitted to the 3 main Montefiore hospitals and diagnosed with COVID-19 RAASi use was defined by a prescription within 365 days prior to hospitalization The association of RAASi use with COVID associated AKI incidence and mortality was evaluated using logistic regression models Propensity score matching was then used to derive the odds ratio (OR) of AKI and death in those using RAASi compared with controls Results: Of 3345 hospitalized patients, 9 3% were prescribed a RAASi prior to hospitalization Those prescribed RAASi were older (71 9 vs 63 6 years, p<0 001), more commonly Black or Hispanic (RAASi users 41 3% Black and 41 0% Hispanic vs non- RAASi 35 4% Black and 36 9% Hispanic) and had higher Charlson co-morbidity scores (median 4 (IQR 3-7) for RAASi users vs 2(1-3) for non-RAASi users) In unadjusted analysis, RAASi use was associated with a higher OR for AKI (OR 1 32(95% CI 1 04- 1 68)) and a higher OR for death (OR 1 53 (95% CI 1 18-1 98) Multivariate adjustment for age, demographics, and clinical comorbidity attenuated associations of AKI and death towards the null (AKI: OR 1 00 (95% CI 0 76-1 31);Death: OR 0 92 (95% CI 0 68- 1 24)) Similarly, in propensity score analysis there was no association between RAASi use and either AKI (OR 0 96 (95%CI 0 88-1 04)) or death (OR: 0 96 (95%CI 0 89-1 05) Conclusions: RAASi use prior to hospitalization was not associated with AKI or inhospital mortality in a cohort of patients hospitalized with COVID-19