Complications of remdesivir in COVID-19 patients with kidney disease: a retrospective cohort study

Introduction: The COVID-19 pandemic has highlighted the vulnerability of patients with chronic kidney disease (CKD) to severe complications from the virus. Remdesivir, an antiviral drug initially developed for Ebola, has emerged as a treatment option for COVID-19, yet its safety and efficacy in patients with kidney disease remain under investigation. Objectives: This study aims to evaluate the complications associated with remdesivir in COVID-19 patients who have pre-existing kidney conditions. Patients and Methods: This retrospective cohort study involved 230 COVID-19 patients who were referred to Hasheminejad hospital in Tehran between October 2021 and July 2022, all of whom received a minimum of 100 mg of remdesivir. Participants were categorized based on their history of kidney disease into groups comprising those with CKD, end-stage renal disease (ESRD), and kidney transplant (KT) recipients as well as patients without a history of kidney disease including those with consistently normal kidney function. The study assessed demographic data and laboratory parameters related to liver function, specifically measuring alanine aminotransferase (ALT) and aspartate aminotransferase (AST), along with lactate dehydrogenase (LDH) levels, as well as inflammatory markers, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), at both baseline and post-treatment intervals. Data were compared between groups using analytical tests. Results: Out of 230 included patients, 145 showed no kidney impairment, while 30 had CKD, 35 had undergone KT, and 20 were ESRD. The results indicated that there were no significant differences in liver enzyme levels (including AST and ALT), inflammatory markers (including CRP and ESR), and LDH, from pre- to post-administration of remdesivir between patients with kidney impairment and those without. Additionally, no differences were found among different kidney impairment groups such as CKD, KT, and ESRD. However, LDH and ESR levels were significantly higher in KT patients compared to those without kidney impairment, raising potential concerns for this population. Conclusion: The findings suggest that remdesivir-related complications concerning liver function, inflammatory markers, and LDH levels did not show significant differences between patients with or without kidney impairment, particular attention should be given to KT recipients due to observed significant increases in LDH and ESR, which may indicate a higher risk of adverse outcomes in this vulnerable population.