Remdesivir May Be Safe for Patients With COVID-19 Regardless of Renal Impairment

Patients with severe renal failure should be considered candidates for remdesivir treatment for COVID-19 pneumonia despite advice against it, suggest study findings published in Infection.

“Remdesivir is currently the only US Food and Drug Administration-approved medication for the treatment of COVID-19, however the recommendation against the use in patients with eGFR [estimated glomerular filtration rate] less than 30 mL/min may prevent the use of this medication in this patient population who can potentially benefit from this treatment,” researchers wrote.

To evaluate the safety of remdesivir in patients with severe renal failure, the retrospective study focused on 416 adults with COVID-19 who received remdesivir between May 1, 2020, and April 30, 2021, at Kings County Hospital Center in Brooklyn, New York. For the analysis, patients were divided into two groups based on estimated creatinine clearance (eCrCl). A total 55 patients were in the eCrCl <30 mL/min group, and 361 were in the eCrCl ≥30 mL/min group.

The study found no significant differences in acute kidney injury or hepatotoxicity between the groups. The acute kidney injury incidence was 11% in the eCrCl <30 mL/min group compared with 7% in the eCrCl ≥30 mL/min group. Hepatotoxicity as measured by alanine aminotransferase was 2% in the eCrCl <30 mL/min group compared with 4% in the eCrCl ≥30 mL/min group; hepatotoxicity as gauged by aspartate aminotransferase was 2% for each of the groups.

“Despite the fact that patients with eCrCl <30 mL/min were more likely to be older, have more comorbidities that may predispose renal dysfunction (hypertension, diabetes mellitus), and were more likely to be admitted to the intensive care unit and receive vasopressors, the incidence of acute kidney injury being similar between the two groups may indicate that remdesivir use is safe in this subset of patients,” researchers wrote.

Average length of stay was 6.7 days longer in the eCrCl <30 mL/min group, the study showed, which researchers believe was a reflection of higher illness severity in the group. Nevertheless, there was no significant between-group difference in mortality: 21.8% the eCrCl <30 mL/min group and 18.8% in the eCrCl ≥30 mL/min group.

“Based on these results, remdesivir should be considered as a therapeutic option in patients with severe renal failure,” researchers concluded, “however larger, controlled trials are warranted to further investigate the use of remdesivir in this patient population.”

Reference:
Sunny S, Samaroo-Campbell J, Abdallah M, Luka A, Quale J. Is remdesivir safe in patients with renal impairment? Experience at a large tertiary urban medical center. Infection. Published online May 26, 2022. doi:10.1007/s15010-022-01850-7