Remdesivir in Patients With Acute or Chronic Kidney Disease in Covid-19 and Impact on Liver and Kidney Function

Abstract

Introduction: Acute Kidney Injury is commonly present in Covid-19 hospitalised patients whereas chronic kidney disease and end-stage renal disease are also common comorbidities in patients who develop severe COVID-19. These patients require antiviral medication as early as possible but there is no current guidelines for use of Remdesivir therapy in these patents and drug is not used initially in these patients. Antiviral strategies are desperately needed in this population to treat these patients as early as possible. Material And Methods: We conducted an observational, retrospective cohort study of adults with COVID-19 conrmed by RT-PCR who had eGFR < 30mL/min/1.73m2 or received RRT prior to receiving at least one dose of Remdesivir. eGFR was estimated from the serum creatinine value just prior to the rst dose of Remdesivir using the Chronic Kidney Disease Epidemiology Collaboration calculator. The majority of patients requiring supplemental oxygen were offered Remdesivir; eGFR cut-offs were not used as a strict exclusion criteria. All patients with eGFR < 30mL/min/1.73m2 who received at least one dose of Remdesivir in hospital were included in the study. AKI was dened as at least a 1.5- fold rise in creatinine from baseline per KDIGO criteria. CKD was dened as eGFR < 60mL/min/1.73m2 between 7-365 days prior to admission. Patients with “stable CKD” did not meet criteria for AKI at the time of starting Remdesivir. ESRD was dened as requiring RRT > 3 months prior to hospitalization. The primary objectives were to describe changes in ALT, AST, and Bilirubin and serum creatinine during Remdesivir therapy, and to report adverse effects attributed to Remdesivir. A Results: total of 41 patients with eGFR <30 ml/min per 1.73 m2 at the time of Remdesivir initiation were included in the study. 27 patients were in intensive care, and 14 patients were mechanically ventilated at the time of Remdesivir initiation. At the time of Remdesivir initiation, 30 patients were receiving RRT. 11 patients with eGFR <30 ml/min per 1.73 m2 were not on RRT at the time of starting Remdesivir. Four patients developed ALT more than the upper limit of normal and only two patients developed ALT more than 5 times, that may be contributory to other factor also. In general, limited information is available Conclusion: on the impact of SARS-CoV-2 infection in patients with eGFR less than 30. Impact of Remdesivir on these patients and their liver and kidney functions are not well studied. Although the available clinical data are limited, but it shows that impact of Remdesivir on liver and kidney function in patients of eGFR less than 30 is limited. However further studies are needed.