From the Guidelines
Remdesivir is not recommended for patients with severe Chronic Kidney Disease (CKD) with an eGFR <30 mL/min/1.73 m2, according to the FDA guidelines 1. For patients with mild to moderate CKD (eGFR ≥30 mL/min), the standard remdesivir regimen of 200 mg IV on day 1 followed by 100 mg IV daily for a total of 5-10 days can be used without adjustment. Key considerations for remdesivir use in CKD patients include:
- Monitoring of renal function and liver enzymes during treatment, as remdesivir has been associated with transaminase elevations and renal toxicity 1
- Discontinuation of remdesivir if ALT levels increase to ≥5 times the upper limit of normal or any ALT elevation is accompanied by signs or symptoms of liver inflammation, or increasing conjugated bilirubin levels, alkaline phosphatase levels, or INR 1
- Individualized benefit-risk assessment, particularly in severely ill COVID-19 patients with CKD where treatment options may be limited 1 The FDA recommends assessing kidney and hepatic function at baseline and during treatment, and discontinuing remdesivir if significant adverse events occur 1.
From the Research
Dosing Recommendations for Remdesivir in CKD Patients
- The dosing recommendations for Remdesivir in patients with Chronic Kidney Disease (CKD) are not well established, as patients with severe kidney function impairment were excluded from large clinical trials 2, 3.
- However, studies suggest that Remdesivir can be used safely in patients with impaired kidney function, including those with an estimated glomerular filtration rate (eGFR) between 15-60 mL/min/1.73m2 2.
- A retrospective multicenter study found that the use of Remdesivir in patients with advanced kidney disease (GFR < 30 mL/min/1.73m2) was not associated with an increased risk of adverse kidney outcomes 3.
- A systematic review of 22 studies found that Remdesivir administration in COVID-19 patients with renal impairment was not associated with an increase in adverse effects, and may even be beneficial in acute kidney injury induced by COVID-19 4.
Considerations for Dosing Adjustment
- Dosing adjustment guidelines for medications in patients with renal impairment are often inconsistent and lacking in quantitative data 5.
- A study found that a renal drug dosing service can increase the proportion of drug dosing that is adjusted to take into account renal function, and may prevent adverse drug events and save drug costs 6.
- It is essential to consider the individual patient's renal function and other factors when determining the appropriate dose of Remdesivir, and to monitor for potential adverse effects 2, 3, 4.
Safety and Efficacy
- The safety and efficacy of Remdesivir in patients with CKD have been evaluated in several studies, with results suggesting that it can be used safely and effectively in this population 2, 3, 4.
- However, larger, well-designed studies are needed to confirm these findings and provide more definitive guidance on the use of Remdesivir in patients with CKD 4.