Background: There are scarce data regarding the use of remdesivir in patients with severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) and end-stage renal disease as US Food and Drug Administration cautions against its use in patients with an estimated glomerular filtration rate <30 ml/min/ 1.73m 2 unless the potential benefits outweigh the potential risks. We studied the compassionate use and safety profile of remdesivir in patients with end-stage renal disease and moderate to severe SARS-CoV-2 infection. Methods:We conducted an observational prospective study in 48 dialysis-dependent patients with SARS-CoV-2 infection who received remdesivir as part of institutional treatment protocol. During the treatment period, 100 mg of remdesivir was given 4 hours before hemodialysis sessions. Liver function tests, inflammatory markers such as serum C-reactive protein, serum ferritin and lactate dehydrogenase levels, and oxygen requirement before and after remdesivir treatment were compared.Results: There were no events of significant liver function test alterations with the administration of 2 to 6 doses of remdesivir. A significant decline in serum C-reactive protein level (P < 0.001) was noted. More than two thirds (68.57%) of patients showed an improvement in oxygen requirement. Early administration of remdesivir within 48 hours of hospital admission shortened the duration of hospitalization by a mean of 5.5 days (P ¼ 0.001). Conclusion:Remdesivir was well tolerated and found safe in our study. If initiated within 48 hours of hospitalization, it reduces recovery time. Assessing the mortality benefits of remdesivir in these patients requires a randomized controlled trial with a larger population.

Background: The passive immunization of patients with SARS-CoV2 with convalescent plasma (CP) is theoretically beneficial in patients with end-stage renal disease who are immunosuppressed and unable to mount an adequate immune response. Hence, this study was conducted to evaluate the safety and efficacy of CP in patients with chronic kidney disease on hemodialysis with moderate-to-severe SARS-CoV2 infection.Methods: A prospective observational cohort study was conducted in consecutive 68 moderate-to-severe SARS-CoV2 infected patients who were on maintenance hemodialysis or with acute worsening of chronic kidney disease which required initiation of hemodialysis. Patients who received CP were compared with those who did not. The primary outcome was death during hospitalization. Clinical characteristics, duration of hospitalization and inflammatory parameters were compared between the two groups. A subgroup analysis was done to find whether early initiation of plasma was associated with better outcome. Results: Sixteen patients (44%) in the plasma group and 14 (45%) patients in the control group died during hospitalization (p = 0.95). The median duration of hospitalization was 9 (6-14) days in the plasma group and 9 (6-16) in the control group (p = 0.60). There was no difference in mortality or duration of hospitalization with respect to early initiation of CP (p = 0.29). Fistula thrombosis occurred in two patients (11.1%) in the plasma group. Conclusion:Therapy with CP does not appear to confer any clinical benefit in moderate-to-severe SARS-CoV-2 infected patients with chronic kidney disease on hemodialysis.

Introduction In this observational study, we describe the change in the clinical profile and outcome of Corona Virus Disease 2019 (COVID-19) over the course of the outbreak, among patients requiring dialysis, including chronic haemodialysis therapy. Methods This is a single-centre prospective observational study of patients with COVID-19 (as confirmed by RT-PCR) and renal failure requiring haemodialysis. Their clinical profiles and outcomes were analysed, vis-à-vis the changing disease severity. Findings A total of 483 patients were included, of whom 416 had end-stage renal disease and were on maintenance haemodialysis. Patients who were symptomatic at presentation had significantly higher levels of Neutrophil–lymphocyte ratio (NLR) ( p < 0.001), C-reactive protein (CRP) ( p < 0.001), lactate dehydrogenase (LDH) ( p < 0.001), higher degrees of lung involvement ( p < 0.001) and required more respiratory support ( p < 0.001). The overall mortality observed was 18.8%. In the late phases of the outbreak, there was a significant increase in disease severity without a statistically significant increase in mortality. Predictors of mortality on univariate analysis were age, diabetes mellitus, acute on chronic kidney disease, presence of symptoms on admission, NLR, CRP, LDH, computed tomography (CT) chest grades 3 and 4, and need for respiratory support; however, only age and the renal syndrome of acute on chronic kidney disease retained significance on multivariate analysis ( p 0.003 and p 0.019, respectively). Conclusion Among patients on haemodialysis, higher mortality was observed in patients who were older, and among those with acute on chronic kidney disease. In the late phase of the outbreak, there was a statistically significant increase in disease severity without a corresponding increase in mortality. Graphic abstract Supplementary Information The online version contains supplementary material available at 10.1007/s40620-021-01072-4.

criteria were prospectively followed up for 6 months with relevant clinical data and laboratory investigations. Electron microscopy and genetic testing was done wherever feasible. At 6 months of follow up the outcomes were analyzed. Factors affecting disease progression were studied. Results: We had 33 patients out of which 27 had C3GN and 6 had atypical HUS. Majority were in age group 31-40yrs. 57.6% were males. The most common clinical syndrome was acute nephritic illness (30.3%). Positive family history was present in 9.09%. 29 patients had hypertension at onset of disease. 27 patients had proteinuria > 1 g per day. Micro hematuria was present in 91%. Abnormal GFR at presentation was seen in in 25 patients. The mean serum creatinine at onset was 3.8AE2.76 mg/dl. 93.9% had low serum C3. The mean hemoglobin of 6.33AE0.63g/dl and mean platelet count of 0.56AE0.30 lakhs/mm3 in aHUS group.The most common pattern on light microscopy was MPGN (8 patients). Crescents in biopsy was seen in 26.66% and 23.3% had severe IFTA. The most frequent deposits were subendothelial in electron microscopy. Genetic study was done for 13 patients and 10 of them (76.9%) had positive mutation. The most frequent mutations were in CFHR genes. 87.8% of patients (29/33) received steroids. 9 patients (27.27%) received MMF while 4 patients (12.12%) received CNI and 3 patients with Crescentic GN (9.09%) received cyclophosphamide. 5 aHUS patients received therapeutic plasma exchange and 1 received only plasma infusion in addition to steroids. Most of the patients received at least 4-6 months of immunosuppression. 21% of patients had dialysis requiring renal failure at onset. At 6 months 29 patients survived out of which 37.9% progressed to ESRD. 3 of them underwent transplant. 4 patients died during follow up.44.44% of patients with no ESRD had persistent micro hematuria and hypertension. The total remission with steroids only was 71.4%, with steroids plus MMF was 66.6% and with steroids plus CNI was 75%. In atypical HUS only 40% achieved remission with TPE and immunosuppression. Multivariate regression analysis showed serum creatinine at diagnosis and IFTA on biopsy as predictors of disease progression. Conclusions: Alternate complement pathway dysregulation in this study resulted in C3GN and atypical HUS. There was 33% progression to ESRD. We have limited access to complement therapeutics and hence less costlier but effective treatment strategies are definitely the need of the hour.