Remdesivir use for COVID-19 patients: Rates of serum creatinine levels to baseline or to upper limits to monitor postadministration renal function

Abstract

Objectives: The incidence of remdesivir-induced renal dysfunction has not been investigated until now. The present study explored the clinical factors and laboratory data that predict remdesivir-induced renal dysfunction. The subjects were COVID-19 patients and we determined the endpoint as dialysis or death within 29 days. Background status parameters included (1) estimated glomerular filtration rate < 30 ml/min/1.73 m2, (2) serum creatinine (SCr) ratios to baseline > 1.5, (3) SCr ratios to upper limits > 1.5, (4) alanine aminotransferase ratios to upper limits > 5, (5) administration days, (6) sex, (7) age, (8) height, (9) weight, (10) dexamethasone use, and (11) SARS-CoV-2 vaccination. Results: In a total of 490 patients, a multivariate analysis showed that status (2) (odds ratio [OR] 8.342, 95% confidence interval [CI] 1.589-43.788, P=0.012) and status (7) (OR 7.620, CI 1.181-49.169, P=0.033) at 72 years or more were significant factors for remdesivir-induced renal dysfunction. To monitor renal function after remdesivir administration in COVID-19 patients, SCr ratios to baseline may work better than those to the upper limits.