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Oxford University Press - PMC COVID-19 Collection logoLink to Oxford University Press - PMC COVID-19 Collection
. 2020 Dec 14:ciaa1851. doi: 10.1093/cid/ciaa1851

Remdesivir Use in the Setting of Severe Renal Impairment: A Theoretical Concern or Real Risk?

Natasha N Pettit 1,, Jennifer Pisano 2, Cynthia T Nguyen 1, Alison K Lew 1, Aniruddha Hazra 2, Renslow Sherer 2, Kathleen Mullane 2
PMCID: PMC7799321  PMID: 33315065

Abstract

Introduction

Remdesivir (RDV) is FDA approved for COVID-19, but not recommended for patients with severe renal impairment (SRI, i.e. creatinine clearance < 30ml/min). Few studies have evaluated RDV in patients with SRI due to theoretical toxicity concerns.

Methods

Hospitalized patients receiving RDV for COVID-19 between 5/1/2020-10/31/2020 were analyzed in a retrospective chart review. We compared incident adverse events (AEs) following RDV in patients with and without SRI, including hepatotoxicity, nephrotoxicity, any reported AE, mortality and length of stay.

Results

A total of 135 patients received RDV, 20 patients had SRI. Patients with SRI were significantly older (70 vs. 54 years, p=0.0001). The incidence of possible AEs following RDV was 20% among those with SRI versus 11% without (p=0.26). LFT elevations occurred in 10% vs. 4% (p=0.28), and SCr elevations occurred in 20% vs. 6% (p=0.06) of patients with SRI versus those without, respectively. The LFT and SCr elevations were not attributed to RDV in either group. Mortality and length of stay were comparable and consistent with historical controls.

Conclusion

RDV AEs occurred infrequently with low severity and were not significantly different between those with and without SRI. While a higher percentage of patients with SRI experienced SCr elevations, 3 (75%) patients were in AKI prior to RDV. Overall, the use of RDV in this small series of patients with SRI appeared to be relatively safe, and the potential benefit outweighed the theoretical risk of liver or renal toxicity; however, additional studies are needed to confirm this finding.

Keywords: COVID-19, remdesivir, renal impairment


Articles from Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America are provided here courtesy of Oxford University Press

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