shan wang, BCCCP, BS, PharmD
critical care pharmacist
NYU Langone Hospital - Long Island
mineola, New York, United States
Disclosure information not submitted.
D'Andrea Joseph, MD
Chief, Trauma Service
NYU Langone Hospital Long Island
mineola, New York, United States
Disclosure information not submitted.
Shahidul Islam, DrPH, MPH
Research Assistant Professor and Director, Biostatistics Core
NYU Long Island School of Medicine
Mineola, New York, United States
Disclosure information not submitted.
Naveed Masani, MD
Dr.
NYU Langone Hospital Long Island
mineola, New York, United States
Disclosure information not submitted.
Title: Remdesivir use in patients with renal impairment
Purpose: Conclusive data on safety of remdesivir in renal impaired as well as the incidence of liver injury are lacking. The primary objective of this study is to assess the incidence of acute kidney injury (AKI) and to trend the liver function tests (LFTs) during remdesivir treatment and change in eGFR from baseline to end of remdesivir treatment as well as 48 hours after completion of therapy.
Methods: This is a retrospective chart review study including adult Covid19 patients receiving remdesivir with a baseline eGFR< 30ml/min per 1.73 m^2 from December 2020 to May 2021. The primary outcome of the study is the incidence of AKI and hepatic injury. The secondary outcome is to assess the efficacy of remdesivir defined by oxygen requirement during therapy.
Results: Seventy-one patients were included in the study. Average eGFR improved by 30.3% at the immediate end of remdesivir treatment and by 30.6% at 48 hours after the end of the treatment (both P< 0.0001). Comparing to baseline, creatinine at the end of remdesivir treatment decreased by 20.9% (P< 0.0001), creatinine of 48 hour after remdesivir treatment decreased by 20.5% (P< 0.0001). Creatinine clearance increased by 26.6% (P< 0.0001) at end of treatment and increased by 26.2% (P< 0.0001) by 48 hours after end of treatment. AST average increased by 2.5% at the end of remdesivir treatment (P=0.727). At 48 hours after remdesivir completion, average AST dropped by 15.8% (P=0.021). ALT average increased by 25% (P=0.004) at the end of remdesivir treatment and increased by 12.0% (P=0.137) at 48 hours after remdesivir completion. Both direct and total bilirubin at end of remdesivir treatment as well as 48 hours later remained stable and did not have significant changes from baseline (P >0.05). Overall, 38% (27 out of 71 patients) experienced oxygenation improvement shown by down-titration of oxygen therapy. Fifty-seven percent of patients received other nephrotoxic medications. The mortality rate is 33.8%. Fifteen of the 71 patients were admitted into ICU. Sixty-five percent (46/71) patients were discharged alive from hospital.
Conclusion: This study showed that remdesivir use in renally impaired Covid 19 patients with eGFR< 30ml/min is safe and effective. However, large and prospective studies are needed to validate our findings.