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Purpose <p>Nephrectomy can lead to hyperfiltration, focal segmental glomerulosclerosis (FSGS) and end-stage kidney disease (ESKD). We hypothesize that medications decreasing intraglomerular pressure have a positive impact on glomerular filtration among other outcomes after unilateral nephrectomy. The study investigated the possible impact of the SARS-CoV2 infection known as COVID-19 on outcomes among the unilateral nephrectomy recipients.</p> Methods <p>National Clinical Cohort Collaborative (N3C) database COVID19 Enclave was analyzed using multivariable linear regression and specific outcomes of eGFR values up to 3&#xa0;years post-nephrectomy, occurrence of ESKD, HTN, FSGS, and gout.</p> Results <p>In the non-COVID19 group, use of ACEi or ARB alone associated with a decrease in eGFR between 1 and 3&#xa0;years (−&#xa0;2.71 95% [−&#xa0;3.90 to −&#xa0;1.52]; <i>p</i> &lt; 0.001), use of SGLT2i alone correlated with an increase (Coef 5.04 95% [0.781–9.301]; <i>p</i> = 0.02) while the concomitant use of ACEi or ARB with SGLT2i was not related to a variation in eGFR. These associations were not observed in the COVID19 group. COVID19 infection associated with an increased risk of post-nephrectomy ESKD development (HR 1.309 95% [1.066, 1.607]; <i>p</i> = 0.01), FSGS (HR 6.952 95% [2.685, 18.00]; <i>p</i> &lt; 0.001) and gout (HR 1.411 95% [1.043, 1.907]; <i>p</i> = 0.025).</p> Conclusion <p>RAS blockade did not demonstrate any significant impact on the incidence of FSGS. The analysis was limited due to the absence of patients with both SGLT2i use and FSGS. SGLT2 inhibition correlated with an overall beneficial effect on the eGFR trend post-nephrectomy.</p>

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Post-nephrectomy outcomes in COVID-19 and non-COVID-19 Patients using ACEi, ARB and SGLT2i: a N3C database study

  • 期刊论文

  • 发表日期：

    2026年3月8日

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  • Jordan Loon,
  • Meng-Hao Li,
  • Swati Mehta,
  • Jorge Ortiz,
  • Mauricio Monrroy,
  • Loay Salman,
  • Naoru Koizumi,
  • Giovanni Faddoul,
  • Adam B. Wilcox,
  • Adam M. Lee,
  • Alexis Graves,
  • Alfred Jerrod Anzalone,
  • Amin Manna,
  • Amit Saha,
  • Amy Olex,
  • Andrea Zhou,
  • Andrew E. Williams,
  • Andrew M. Southerland,
  • Andrew T. Girvin,
  • Anita Walden,
  • Anjali Sharathkumar,
  • Benjamin Amor,
  • Benjamin Bates,
  • Brian Hendricks,
  • Brijesh Patel,
  • G Caleb Alexander,
  • Carolyn T. Bramante,
  • Cavin Ward-Caviness,
  • Charisse Madlock-Brown,
  • Christine Suver,
  • Christopher G. Chute,
  • Christopher Dillon,
  • Chunlei Wu,
  • Clare Schmitt,
  • Cliff Takemoto,
  • Dan Housman,
  • Davera Gabriel,
  • David A. Eichmann,
  • Diego Mazzotti,
  • Donald E. Brown,
  • Eilis Boudreau,
  • Elaine L. Hill,
  • Emily Carlson Marti,
  • Emily R. Pfaff,
  • Evan French,
  • Farrukh M Koraishy,
  • Federico Mariona,
  • Fred Prior,
  • George Sokos,
  • Greg Martin,
  • Harold P. Lehmann,
  • Heidi Spratt,
  • Hemalkumar B. Mehta,
  • J.W. Awori Hayanga,
  • Jami Pincavitch,
  • Jaylyn Clark,
  • Jeremy Richard Harper,
  • Jessica Yasmine Islam,
  • Jin Ge,
  • Joel Gagnier,
  • Johanna J. Loomba,
  • John B. Buse,
  • Jomol Mathew,
  • Joni L. Rutter,
  • Julie A. McMurry,
  • Justin Guinney,
  • Justin Starren,
  • Karen Crowley,
  • Katie Rebecca Bradwell,
  • Kellie M. Walters,
  • Ken Wilkins,
  • Kenneth R. Gersing,
  • Kenrick Cato,
  • Kimberly Murray,
  • Kristin Kostka,
  • Lavance Northington,
  • Lee Pyles,
  • Lesley Cottrell,
  • Lili M. Portilla,
  • Mariam Deacy,
  • Mark M. Bissell,
  • Marshall Clark,
  • Mary Emmett,
  • Matvey B. Palchuk,
  • Melissa A. Haendel,
  • Meredith Adams,
  • Meredith Temple-O’Connor,
  • Michael G. Kurilla,
  • Michele Morris,
  • Nasia Safdar,
  • Nicole Garbarini,
  • Noha Sharafeldin,
  • Ofer Sadan,
  • Patricia A. Francis,
  • Penny Wung Burgoon,
  • Philip R. O. Payne,
  • Randeep Jawa,
  • Rebecca Erwin-Cohen,
  • Rena C. Patel,
  • Richard A. Moffitt,
  • Richard L. Zhu,
  • Rishikesan Kamaleswaran,
  • Robert Hurley,
  • Robert T. Miller,
  • Saiju Pyarajan,
  • Sam G. Michael,
  • Samuel Bozzette,
  • Sandeep K. Mallipattu,
  • Satyanarayana Vedula,
  • Scott Chapman,
  • Shawn T. O’Neil,
  • Soko Setoguchi,
  • Stephanie S. Hong,
  • Steven G. Johnson,
  • Tellen D. Bennett,
  • Tiffany J. Callahan,
  • Umit Topaloglu,
  • Valery Gordon,
  • Vignesh Subbian,
  • Warren A. Kibbe,
  • Wenndy Hernandez,
  • Will Beasley,
  • Will Cooper,
  • William Hillegass,
  • Xiaohan Tanner Zhang

摘要

Purpose

Nephrectomy can lead to hyperfiltration, focal segmental glomerulosclerosis (FSGS) and end-stage kidney disease (ESKD). We hypothesize that medications decreasing intraglomerular pressure have a positive impact on glomerular filtration among other outcomes after unilateral nephrectomy. The study investigated the possible impact of the SARS-CoV2 infection known as COVID-19 on outcomes among the unilateral nephrectomy recipients.

Methods

National Clinical Cohort Collaborative (N3C) database COVID19 Enclave was analyzed using multivariable linear regression and specific outcomes of eGFR values up to 3 years post-nephrectomy, occurrence of ESKD, HTN, FSGS, and gout.

Results

In the non-COVID19 group, use of ACEi or ARB alone associated with a decrease in eGFR between 1 and 3 years (− 2.71 95% [− 3.90 to − 1.52]; p < 0.001), use of SGLT2i alone correlated with an increase (Coef 5.04 95% [0.781–9.301]; p = 0.02) while the concomitant use of ACEi or ARB with SGLT2i was not related to a variation in eGFR. These associations were not observed in the COVID19 group. COVID19 infection associated with an increased risk of post-nephrectomy ESKD development (HR 1.309 95% [1.066, 1.607]; p = 0.01), FSGS (HR 6.952 95% [2.685, 18.00]; p < 0.001) and gout (HR 1.411 95% [1.043, 1.907]; p = 0.025).

Conclusion

RAS blockade did not demonstrate any significant impact on the incidence of FSGS. The analysis was limited due to the absence of patients with both SGLT2i use and FSGS. SGLT2 inhibition correlated with an overall beneficial effect on the eGFR trend post-nephrectomy.