COVID-19 Patients with Kidney Disease and Completion of Remdesivir Treatment

Remdesivir is a nucleotide analog used to treat coronavirus disease 2019 (COVID-19). We determined whether reduced kidney function is associated with the completion of a full course of remdesivir in hospitalized patients with COVID-19.

This was a retrospective study of 1103 adults hospitalized with COVID-19. The primary outcome was completion of a full course of remdesivir therapy. Secondary outcomes were in-hospital mortality, length of hospital stay, and liver function tests five times greater than the upper limit of normal. The main predictor variable was glomerular filtration rate (GFR; mL/min), which was categorized as >59, 30 to 59, 15 to 29, and < 15.

The GFR groups of 15 to 29 (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.35-0.996, P = 0.048) and < 15 (OR 0.34, 95% CI 0.16-0.71, P = 0.01) were each significantly associated with decreased odds for the completion of a full course of remdesivir therapy. The GFR groups of 30 to 59 (OR 2.29, 95% CI 1.60-3.27, P < 0.001), 15-29 (OR 4.77, 95% CI 2.77-8.21, P < 0.001), and < 15 (OR 2.41, 95% CI 1.06-5.47, P = 0.04) were each significantly associated with increased odds for mortality. The GFR 15 to 29 group was significantly associated (β = -0.14, standard error = 0.05, P = 0.002) with decreased length of hospital stay. No significant association occurred for GFR and liver function tests.

Individuals with lower GFR had lower odds to receive at least 5 days of remdesivir when compared with those with a GFR >59. We recommend that clinicians be aware that patients with kidney disease may not be able to complete a full course of therapy.