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

Abstract

Background: COVID-19 is considered the most challenging global pandemic. Patients with COVID-19 are more vulnerable to renal impairment especially those admitted to the Intensive Care Units (ICUs).
 Objective: In this review we discuss the epidemiology, the pathophysiology, the clinical implications and specific COVID-19 therapy in CKD patients.
 Results: The prevalence of CKD patients with COVID-19 varies between 0.7 to 47.6%. Patients with CKD ought to be encouraged to take extra precautions (isolation, distancing, wearing Personal Protective Equipment (PPE)) to limit the risk of exposure to the virus. Renin-Angiotensin System (RAS) and SARS-CoV-2 interactions, through the binding of the virus to ACE-2, have produced speculations of both likely damage and advantage of RAS inhibitor use during the pandemic. Remidisivir should be avoided in CKD patients (Cr Cl<30ml/min) with COVID-19. In addition, the doses of nephrotoxic medications (chloroquine phosphate and dexamethasone) that are recommended to be used in the management of COVID-19 should be adjusted according to creatinine clearance and dialysis.
 Conclusion: COVID-19 may worsen the impaired kidney function and increase mortality. Care givers should pay especial attention to medications dosing in COVID-19 patient with CKD history.

Current Pharmaco-therapeutic Approach on COVID-19 Admitted Patients in a Corona-dedicated Hospital in Khulna

“…12,27,30 Some studies showed that other antivirals like darunavir/ cobicistat, ribavirin, favipiravir, umifenovir, oseltamivir can play an important role in the treatment of COVID-19. 4,9,12,13,22,27,30 A few patients (severe &critical cases) received tocilizumab (9.52%) as monoclonal antibody, IL-6 receptor antagonist, which is FDA-approved to treat cytokine release syndrome. It may have a beneficial role in severe and life-threatening illness.…”

“…1,2 Mortality rates of Coronavirus Disease 2019 (COVID- 19) have been estimated to be 5-27% 2,3 which is more prevalent in vulnerable populations, including children, older people, pregnant women & patients with existing co-morbidities like DM, HTN, IHD, CVD, Asthma, etc. [1][2][3][4][5][6][7] No specific pharmacological treatment or vaccine has been invented against SARS-CoV-2 to save the people yet. 8,9 Various "repositioned" drugs (indicated for other uses) have been proposed for COVID-19 treatment.…”