Current treatment of COVID-19 in renal patients: hope or hype?

Abstract

To date the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), known as COVID-19, is for clinicians the most difficult global therapeutic problem. In this landscape, the management of patients with chronic kidney disease, acute kidney injury or patients undergoing immunosuppressant therapies for kidney transplant or glomerular diseases, represent a clinical challenge for nephrologists, especially in patients with severe acute lung involvement. Therefore in this setting, due to the lack of anti-COVID treatment schedules, tailored management is mandatory to reduce the side effects, as consequence of impaired renal function and drugs interactions. We report the main treatment actually used against SARS-CoV-2, underlining its possible use in the nephropatic patients and the central role of nephrologists to improve the clinical outcome.

The role of continuous renal replacement therapy (Crrt) in Coronavirus disease 2019 (Covid-19) patients

“…On the other hand, lopinavir/ritonavir and azithromycin has high protein binding property and high volume of distribution which make them difficult to remove by the CRRT. 57 , 58 …”

Pharmacotherapy for Patients with Chronic Kidney Disease during the COVID-19: A Narrative Review

“…Furthermore, a recent study reported principal treatments currently used against COVID-19 [6]. These drugs must be used with causation in patients with different degree of CKDs including those on dialysis Table 1.…”

“…Clinical features of COVID-19 disease can differ from minor selfrestricted flu-like manifestations to severe acute respiratory syndrome (SARS) with likely combination with multi-organ failure as a result of cytokine storm or hemophagocytic syndrome. In renal patients, the last conditions speak to a true test concerning care and endurance [6]. CKD patients are more susceptible to COVID-19 than the general population.…”

“…In this landscape, different methods of management have been developed for acute respiratory distress syndrome (ARDS) secondary to COVID-19 [8]. Furthermore, because of the unforeseen and rapid blast of the spread and the absence of new compelling treatments, healthcare professionals are measuring the impact of medications utilized for other viral infections [9] Presently, nephrologists are utilizing the recommnded medications with specific regard for the renal impairment degree, interactions with different drugs and, dialytic clearance in patients on dialysis [6]. In this review, we discuss the epidemiology, the pathophysiology, the clinical implications, and specific COVID-19 therapy in CKD patients.…”

Clinical Characteristics, Treatments and Outcomes of 18 Lung Transplant Recipients with COVID-19

“…An important issue, especially relevant in the LTR population, is the question of how to treat patients with an impaired renal function. As a prodrug, remdesivir is predominantly metabolized by hepatic enzymes with hydrolase activity [40,41]. Routine monitoring of liver function tests is recommended, and remdesivir should be discontinued in patients with alanine aminotransferase (ALAT) ≥10 times the upper limit of normal.…”