In the analysis of the 59 patients with an estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2 at study randomization, no increased risk for hospital death was identified among those treated with remdesivir rather than standard of care (40.6% vs 52%, respectively; relative risk [RR] 0.78, 95% CI 0.41-1.49), reported Srinivas Murthy, MD, CM, MHSc, of the University of British Columbia in Vancouver, and colleagues. This held true in a model that adjusted for sex and baseline eGFR as well (odds ratio [OR] 0.74, 95% CI 0.23-2.40), the group noted in a research letter in JAMA Network Open. Need for new mechanical ventilation or incidence of any adverse events also trended lower in patients treated with remdesivir:

New mechanical ventilation: RR 0.57 (95% CI 0.15-1.80) Adverse event: RR 0.37 (95% CI 0.05-1.33)

Furthermore, total average length of hospital stay wasn’t significantly different between the groups (23.1 days for remdesivir vs 21.6 for standard of care). In this group of hospitalized patients with severe renal impairment, remdesivir also appeared to be safe for the kidneys, without any additional risk of transaminitis or toxic kidney effects by day 5:

Day 5 eGFR: 31.2 mL/min/1.73 m2 for remdesivir vs 20.5 mL/min/1.73 m2

Day 5 creatinine: 2.83 mg/dL for remdesivir vs 4.12 mg/dL

Day 5 alanine aminotransferase: 40.8 for remdesivir vs 91.9

For patients who didn’t require dialysis at baseline, the need for new dialysis was also no different for those given remdesivir (RR 0.95, 95% CI 0.25-3.56). “These findings suggest that remdesivir can be safely administered in patients with kidney dysfunction, balancing possible risks and benefits,” Murthy’s group said, while noting the small study population as a limitation. This is particularly reassuring as remdesivir is not currently recommended for use in patients with severe renal dysfunction, particularly those with an eGFR below 30, “owing to the presence of excipients that may accumulate in kidney dysfunction and worsen kidney or hepatic outcomes,” the researchers wrote. They added that the “need for assessing kidney function in the absence of clinical suspicion before and during outpatient administration of remdesivir can be questioned.” Data for the analysis came from the Canadian Treatments for COVID-19 (CATCO) trial that was part of the larger global Solidarity Trial. This trial didn’t impose any kidney-specific exclusion criteria to participation. Patients randomized to receive open-label remdesivir were administered lyophilized remdesivir, diluted and administered intravenously with a loading dose of 200 mg on the first day, and then followed by daily 100-mg doses for 9 days or until the patient was discharged. The dose of remdesivir was not adjusted for baseline kidney functioning. Standard of care was delivered in the form of “best-quality supportive care,” the team noted. Along with the small study population (34 patients in the remdesivir group and 25 in the standard-of-care group), the current analysis was also limited by baseline differences, according to the researchers. Between the remdesivir and control groups, respectively, baseline differences included median age (74 vs 80 years), male sex (38.2% vs 68%), median frailty score (4 vs 5), need for intensive care (32.4% vs 28%) or oxygen (47.1% vs 56%), as well as median creatinine (2.62 vs 3.88 mg/dL) and eGFR levels (22.7 vs 12.4 mL/min/1.73 m2), among others.

Kristen Monaco is a staff writer, focusing on endocrinology, psychiatry, and nephrology news. Based out of the New York City office, she’s worked at the company since 2015.

Disclosures The study was funded by the Canadian Institutes of Health Research. Murthy reported a relationship with the Canadian Institutes of Health Research; other co-authors also reported disclosures.