Chronic kidney disease (CKD) and ESKD are also common comorbidities in patients who develop severe COVID-19. Data on use of these agents in CKD and ESRD is limited.
The largest clinical trials evaluating the use of this agent in COVID-19 excluded patients with stage 4 CKD or those requiring dialysis.
A multicenter study from Northwell health, BWH, MGH and U of Miami( of 18 patients) and a large study from India (46 patients) recently looked at use of remdesivir in CKD, AKI and ESKD patients. All patients studied had eGFR<30cc/min.
In the USA study, treatment was well-tolerated, with
few other AEs attributed to remdesivir. Five patients discontinued remdesivir
early, only 2 of them due to AEs attributed to remdesivir (burning at IV site
during the final dose and worsening kidney function); the remainder stopped due
to improved clinical status (N=2) or patient preference (N=1). Overall 28-day
mortality was 44% (8/18). Among patients requiring intensive care at the time
of remdesivir initiation, 8 of 11 died. All 7 patients who were not requiring
intensive care at baseline survived to 28 days.
In the India study, most patients tolerated the infusion well. Liver function remained stable in 28 (60.9%) cases. No patient had a severe rise in AST/ALT >5 times the upper limit of normal, therefore therapy was not required to be discontinued for this reason in any of the patients. No kidney function abnormalities attributable to drug were observed. Fourteen (30.4%) patients died, 24 (52.2%) patients were discharged from the hospital after recovery.
|
Publication |
USA(
Estiverne et al) |
India ( Thakare
et al) |
|
Total #
of AKI on dialysis |
3 |
19 |
|
Total #
of AKI non on dialysis |
5 |
11( 5
transplant patients) |
|
Total #
of CKD patients |
8 |
15 |
|
Total #
of ESKD patients |
2 |
16 |
|
LFT
abnormalities attributed to agent |
3 |
3 |
|
Remdesivir
induced AKI |
1 |
0 |
|
Got 5
days course |
16 |
46 |
|
Got 10
days course |
2 |
0 |
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