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. 2024 Dec;56(1):2361843.
doi: 10.1080/07853890.2024.2361843. Epub 2024 Jun 3.

Safety and effectiveness of remdesivir in hospitalized patients with COVID-19 and severe renal impairment: experience at a large medical center

Hsuan-Yu Chang  1   2 , Chia-Chen Hsu  1   2 , Li-Fang Hu  1   2 , Chian-Ying Chou  1   2 , Yuh-Lih Chang  1   2   3 , Chih-Chia Lu  1   2 , Li-Jen Chang  1
Affiliations

Safety and effectiveness of remdesivir in hospitalized patients with COVID-19 and severe renal impairment: experience at a large medical center

Hsuan-Yu Chang et al. Ann Med. 2024 Dec.

Abstract

Background: Literature on the safety of remdesivir in hospitalized COVID-19 patients with severe renal impairment is limited. We aimed to investigate the safety and effectiveness of remdesivir in this population.

Methods: We conducted a retrospective cohort study of adult hospitalized COVID-19 patients who received remdesivir between April 2022 and October 2022. Outcomes were compared between estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 and ≥30 mL/min/1.73 m2 groups. The primary safety outcomes were acute kidney injury (AKI) and bradycardia, while the primary effectiveness outcomes included mortality in COVID-19-dedicated wards and hospital mortality. Secondary outcomes included laboratory changes, disease progression, and recovery time.

Results: A total of 1,343 patients were recruited, with 307 (22.9%) in the eGFR <30 group and 1,036 (77.1%) in the eGFR ≥30 group. Patients with an eGFR <30 had higher risks of AKI (adjusted hazard ratio [aHR] 2.92, 95% CI 1.93-4.44) and hospital mortality (aHR 1.47, 95% CI 1.06-2.05) but had comparable risks of bradycardia (aHR 1.15, 95% CI 0.85-1.56) and mortality in dedicated wards (aHR 1.43, 95% CI 0.90-2.28) than patients with an eGFR ≥30. Risk of disease progression was higher in the eGFR <30 group (adjusted odds ratio 1.62, 95% CI 1.16-2.26). No difference between the two groups in laboratory changes and recovery time.

Conclusions: Hospitalized COVID-19 patients receiving remdesivir with severe renal impairment had an increased risk of AKI, hospital mortality, and COVID-19 disease progression compared to patients without severe renal impairment.

Keywords: COVID-19; acute kidney injury; remdesivir; severe renal impairment.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Figure 1.
Figure 1.
Flow diagram summarizing the process of enrollment.
Figure 2.
Figure 2.
Kaplan-Meier survival curves of the COVID-19 cohort receiving remdesivir (A) acute kidney injury (B) bradycardia (C) mortality in COVID-19 dedicated ward (D) Mortality in hospital.
See this image and copyright information in PMC

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