Remdesivir Profile Among Patients With or Without Severe Renal Impairment

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Study authors compared incident adverse events following remdesivir use in patients without and without severe renal impairment, including hepatotoxicity, nephrotoxicity, mortality, and length of stay.

Remdesivir (RDV) for the treatment of coronavirus disease 2019 (COVID-19) was relatively safe among patients with severe renal impairment (SRI) compared with patients without SRI. These findings, from a retrospective review of medical records, was published in Clinical Infectious Diseases.

Researchers from the University of Chicago, Illinois, included all patients (N=135) admitted to their hospital between May 1 and October 31, 2020, with COVID-19 who received RDV. SRI, defined by a creatinine clearance (CrCl) less than 30 mL/min or receipt of renal replacement through hemodialysis, peritoneal dialysis, or continuous renal replacement therapy. Clinical outcomes and adverse events were assessed.

In total, 5 patients had end stage renal disease and 15 patients had a CrCl of less than 30 mL/min. Of the patients with a CrCl of less than 30 mL/min, 3 required patients renal replacement therapy during RDV treatment. At baseline, patients with SRI were older (70 vs 54 years; P =.0001) and had lower CrCl (26 vs 88 mL/min; P <.0001).

No drug adverse events differed significantly on the basis of SRI (P =.26). The adverse events included hepatotoxicity, liver function test elevations, bilateral hearing loss, and serum creatinine elevations.

Among patients with SRI, serum creatinine was more elevated (27% vs 6%; P =.02), hospital stay was longer (8.5 vs 7 days; P =.01), and mortality was increased (25% vs 3.5%; P =.004).

Of the patients with SRI who died, the causes of death included cardiac arrest, hypoxic brain injury, cardiac and respiratory failure, hypoxic respiratory failure, and acute respiratory failure. Deaths were observed to occur after completing RDV therapy at 1 day (n=2), 2 days (n=1), 3 days (n=1), and 7 days (n=1).

This study was limited by its small sample sizes and the retrospective review, which may be biased by unknown missing data or record keeping errors.

These data suggested RDV-related toxicities and adverse events were similar among patients with COVID-19 with or without SRI. The study authors recommend for clinicians to make shared decision making with the patient or caregiver weighing the potential risks with the potential benefits of RDV therapy.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Pettit NN, Pisano J, Nguyen CT, et al. Remdesivir use in the setting of severe renal impairment: a theoretical concern or real risk? Clin Infect Dis. Published online December 14, 2020. doi:10.1093/cid/ciaa1851