Remdesivir in Patients With Estimated GFR &lt;30 ml/min per 1.73 m2 or on Renal Replacement Therapy

Estiverne, Christopher; Strohbehn, Ian A.; Mithani, Zain; Hirsch, Jamie S.; Wanchoo, Rimda; Goyal, Pranisha Gautam; Dryden‐Peterson, Scott; Pearson, Jeffrey C; Kubiak, David W.; Letourneau, Alyssa R.; Bhattacharyya, Roby P.; Jhaveri, Kenar D.; Sise, Meghan E.

doi:10.1016/j.ekir.2020.11.025

Cited by 25 publications

(27 citation statements)

References 9 publications

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“…Estiverne et al reported a case series on 18 patients with CrCl<30 ml/min/1.73m 2 or on renal replacement therapy that received remdesivir. Mean CRP and d dimer levels were 133.1 mg/dl and 2196 ng/ml, comparative to our results [13]. 35% of the patients in our study died, slightly higher than prior studies that showed mortality rates of 26-32% [14, 15].…”

Section: Discussioncontrasting

confidence: 63%

Outcomes of COVID-19 among Patients with End Stage Renal Disease on Remdesivir

Selvaraj

Baig

Dapaah-Afriyie

et al. 2021

Preprint

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BACKGROUND: Since the beginning of COVID-19 pandemic, there has been widespread use of remdesivir in adults and children. There is little known information about its outcomes in patients with severe renal dysfunction or end stage renal disease who are on hemodialysis. METHODS: A retrospective, multicenter study was conducted on patients with end stage renal disease on hemodialysis that were discharged after treatment for COVID-19 between April 1st and December 31st, 2020. Primary endpoints were length of stay, mortality, maximum oxygen requirements along with escalation of care needing mechanical ventilation. Secondary endpoints included change in C reactive protein, d dimer levels and disposition. RESULTS: A total of 52 charts were reviewed, of which 28 met the inclusion criteria. 14 patients received remdesivir, and 14 patients did not receive remdesivir. The majority of patients were caucasian, female, with diabetes mellitus and hypertension. Mean age was 65.33 +14.14 years. All the patients in the remdesivir group received dexamethasone as compared to only 30% of patients in the non-remdesivir group. There was no significant difference in C reactive protein, d dimer levels, and disposition between the two groups. Approximately 35% of the patients died, 18% required intensive ventilation and mean length of stay was 12.21 days. DISCUSSION: The study demonstrated no clinically significant difference in length of stay, maximum oxygen requirements or mortality in COVID-19 patients with end-stage renal disease in the remdesivir group as compared to the non-remdesivir group. Further studies are needed to study the effects of remdesivir on the renal function and disease course in patients with chronic kidney disease stage 4 or 5 that are not on dialysis.

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Section: Discussioncontrasting

confidence: 63%

Outcomes of COVID-19 among Patients with End Stage Renal Disease on Remdesivir

Selvaraj

Baig

Dapaah-Afriyie

et al. 2021

Preprint

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“…Pettit et al found no significant increase in adverse events, nor increases in ALT, AST or serum creatinine when remdesivir was given to patients with eGFR < 30mL/min/1.73m 2 compared to patients with eGFR > 30mL/min/.73m 2 , and that none of the transaminase or creatinine elevations were attributed to remdesivir use [27]. Estiverne et al found that among 18 patients with eGFR < 30mL/min/1.73m 2 who received remdesivir, there were 2 cases of transaminitis (ALT or AST > 5 times the upper limit of normal), both of which were attributed to shock liver [30]. Aiswarya et al…”

Section: Discussionmentioning

confidence: 99%

A Propensity Score–Matched Observational Study of Remdesivir in Patients with COVID-19 and Severe Kidney Disease

et al. 2022

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Background: Remdesivir is not currently approved for patients with estimated glomerular filtration rate (eGFR) < 30mL/min/1.73m2. We aimed to determine the safety of remdesivir in patients with kidney failure. Methods: Retrospective cohort study of patients with COVID-19 hospitalized between May 2020 to January 2021 with eGFR <30 mL/min/1.73m2 who received remdesivir and historical controls with COVID-19 hospitalized between March 1, 2020 - April 30, 2020 prior to Emergency Use Authorization of remdesivir within a large healthcare system. Patients were 1:1 matched by propensity scores accounting for factors associated with treatment assignment. Adverse events and hospital outcomes were recorded by manual chart review. Results: The overall cohort included 34 hospitalized patients who initiated remdesivir within 72 hours of hospital admission with eGFR <30 mL/min/1.73m2 and 217 COVID-19 controls with eGFR <30 mL/min/1.73m2. The propensity score-matched cohort included 31 remdesivir treated cases and 31 non-remdesivir-treated controls. The mean age was 74.0 (SD: 13.8), 56.6% female, 67.7% white. A total of 25.5% had end-stage kidney disease. Among patients who were not on dialysis prior to initiating remdesivir, one developed worsening kidney function (defined ≥ 50% increase in creatinine or initiation of kidney replacement therapy) compared to three in the historical control group. There was no increased risk of cardiac arrythmia, cardiac arrest, altered mental status, or clinically significant anemia or liver function test abnormalities. There was a significantly increased risk of hyperglycemia, which may be partly explained by the increased use of dexamethasone in the remdesivir-treated population. Conclusion: In this propensity-score matched study, remdesivir was well tolerated in patients with eGFR < 30 mL/min/1.73m2.

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“…39 However, multiple small case series have suggested remdesivir may be safe in patients with eGFR < 30 mL/min/1,73m 2 or on dialysis. [40][41][42] A post hoc analysis of clinical trial data showed that patients treated with remdesivir had less kidney function decline; 30% of patients receiving placebo experienced a decline in creatinine clearance, whereas only 15% of patients on a 5-day remdesivir course experienced a decline in creatinine clearance. 43 Studies summarizing the inclusion and exclusion criteria of clinical trials of therapeutics for COVID-19 have noted that kidney disease is an exclusion criteria in approximately half of trials.…”

Section: Acute Chronic and End-stage Kidney Disease As Risk Factors For Mortality From Covid-19mentioning

confidence: 99%