A Propensity Score–Matched Observational Study of Remdesivir in Patients with COVID-19 and Severe Kidney Disease
Rituvanthikaa Seethapathy, Sophia Zhao, Joshua D. Long, Ian A. Strohbehn, Meghan E. Sise
Abstract
Key Points Remdesivir was not approved in patients with eGFR <30 ml/min per 1.73 m 2 , and safety data are extremely limited. Compared with matched controls who did not receive remdesivir, there was no increased risk of cardiac, kidney, liver, or neurologic adverse events. Hyperglycemia was more common in remdesivir-treated patients; this may be explained by concomitant dexamethasone use. Background Remdesivir is not currently approved for patients with eGFR <30 ml/min per 1.73 m 2 . We aimed to determine the safety of remdesivir in patients with kidney failure. Methods This study was a retrospective cohort study of patients with COVID-19 hospitalized between May 2020 and January 2021 with eGFR <30 ml/min per 1.73 m 2 who received remdesivir and historical controls with COVID-19 hospitalized between March 1, 2020 and April 30, 2020 prior to the emergency use authorization of remdesivir within a large health care system. Patients were 1:1 matched by propensity scores accounting for factors associated with treatment assignment. Adverse events and hospital outcomes were recorded by manual chart review. Results The overall cohort included 34 hospitalized patients who initiated remdesivir within 72 hours of hospital admission with eGFR<30 ml/min per 1.73 m 2 and 217 COVID-19 controls with eGFR <30 ml/min per 1.73 m 2 . The propensity score–matched cohort included 31 remdesivir-treated patients and 31 nonremdesivir-treated controls. The mean age was 74.0 (SD=13.8) years, 57% were women, and 68% were white participants. A total of 26% had ESKD. Among patients who were not on dialysis prior to initiating remdesivir, one developed worsening kidney function (defined as ≥50% increase in creatinine or initiation of KRT) compared with three in the historical control group. There was no increased risk of cardiac arrythmia, cardiac arrest, altered mental status, or clinically significant anemia or liver function test abnormalities. There was a significantly increased risk of hyperglycemia, which may be partly explained by the increased use of dexamethasone in the remdesivir-treated population. Conclusions In this propensity score–matched study, remdesivir was well tolerated in patients with eGFR <30 ml/min per 1.73 m 2 .