BACKGROUND: COVID-19 is caused by the coronavirus SARS-CoV-2, which uses 
angiotensin-converting enzyme 2 (ACE-2) as a receptor for cellular entry. It is 
theorized that ACE inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) 
may increase vulnerability to SARS-CoV-2 by upregulating ACE-2 expression, but 
ACE-I/ARB discontinuation is associated with clinical deterioration.
OBJECTIVE: To determine whether ACE-I and ARB use is associated with acute 
kidney injury (AKI), macrovascular thrombosis and in-hospital mortality.
METHODS: A retrospective, single-centre study of 558 hospital inpatients with 
confirmed COVID-19 admitted from 1 March to 30 April 2020, followed up until 24 
May 2020. AKI and macrovascular thrombosis were primary end-points, and 
in-hospital mortality was a secondary end-point.
RESULTS: AKI occurred in 126 (23.1%) patients, 34 (6.1%) developed macrovascular 
thrombi, and 200 (35.9%) died. Overlap propensity score-weighted analysis showed 
no significant effect of ACE-I/ARB use on the risk of occurrence of the 
specified end-points. On exploratory analysis, severe chronic kidney disease 
(CKD) increases odds of macrovascular thrombi (OR: 8.237, 95% CI: 1.689-40.181, 
P = 0.009). The risk of AKI increased with advancing age (OR: 1.028, 95% CI: 
1.011-1.044, P = 0.001) and diabetes (OR: 1.675, 95% CI: 1.065-2.633, 
P = 0.025). Immunosuppression was associated with lower risk of AKI (OR: 0.160, 
95% CI: 0.029-0.886, P = 0.036). Advancing age, dependence on care, male gender 
and eGFR < 60 mL min-1 /1.73 m2 increased odds of in-hospital mortality.
CONCLUSION: We did not identify an association between ACE-I/ARB use and AKI, 
macrovascular thrombi or mortality. This supports the recommendations of the 
European and American Societies of Cardiology that ACE-Is and ARBs should not be 
discontinued during the COVID-19 pandemic.