A Review of Remdesivir Use in End Stage Renal Disease (ESRD)

The novel coronavirus disease 2019 (COVID-19) spread quickly worldwide following the first report of pneumonia of unknown cause in Wuhan, China. Since then, the incidence and mortality have continued to rise, with over 120 million cases of COVID-19 globally. The agency for Food and Drug Administration approved Remdesivir for the treatment of COVID-19, in October 2020. This approval supports the use of Remdesivir to treat SARS-CoV-2 infection in adults and children ≥12 years of age who weigh ≥40 kg. The use of Remdesivir in the treatment of COVID-19 patients was timely considering the rapid rate of spread and mortality from the disease, especially among elderly patients and those with existing comorbidities, including renal disease. There have been reports of increased mortality rate in patients with acute kidney injury (AKI) requiring renal replacement therapy following exposure to the virus. While Remdesivir has been considered safe and effective in the treatment of SARS-CoV-2 infection, recommendations have been issued against its use in End-Stage Renal Disease (ESRD) – patients with glomerular infiltration rate (eGFR) <30mL/min/1.73m2. This is due to minimal safety data from clinical trials involving the use of Remdesivir in patients with ESRD and concerns of liver necrosis and renal tubule obstruction from earlier animal studies. This review focuses on existing literature on the use of patients with ESRD and their outcomes. While further studies are needed to prove the safety of Remdesivir among patients with ESRD, available literature shows that the advantages of short-duration therapy (5-10 days) outweigh the risk, especially when combined with hemodialysis and constant monitoring of Remdesivir concentration.