Remdesivir, Renal Function and Short-Term Clinical Outcomes in Elderly COVID-19 Pneumonia Patients: A Single-Centre Study

Abstract

Background

Remdesivir, an antiviral agent able to reduce inflammatory cascade accompanying severe, life-threatening pneumonia, became the first drug approved by the Food and Drug Administration for the treatment of hospitalized patients with coronavirus 2 related severe acute respiratory syndrome (SARS CoV2). As from its previously known clinical indications, the use of remdesivir in the presence of severe renal impairment is contraindicated; however, the impact of remdesivir on renal function in aging patients has not been elucidated.

Subjects and Methods

This retrospective observational study involved 109 individuals consecutively admitted in internal medicine section, Azienda Ospedaliero Universitaria Pisana hospital, in November–December 2020 due to a confirmed diagnosis of SARS CoV2 and receiving remdesivir according to international inclusion criteria. Biochemical variables at admission were evaluated, together with slopes of estimated glomerular filtration rate (eGFR) built during remdesivir treatment. Participants were followed until discharge or exitus.

Results

Patients were stratified according to age (80 formed the study cohort and 29 served as controls); CKD stage III was present in 46% of them. No patients showed any sign of deteriorated renal function during remdesivir. Fourteen patients in the elderly cohort deceased; their eGFR at baseline was significantly lower. Recovered patients were characterized by a relevant eGFR gaining during remdesivir treatment.

Conclusion

We show here for the first time as remdesivir does not influence eGFR in a cohort of elderly people hospitalized for SARS CoV2, and that eGFR gain during such treatment is coupled with a better prognosis.

Keywords:

• remdesivir
• SARS CoV2
• glomerular filtration rate
• aging
• chronic kidney disease

Acknowledgments

We thank Dr Simone Leonetti for his excellent supervision of statistics. Edoardo Biancalana and Martina Chiriacò are co-first authors in this study.

Abbreviations

AA, ambient air; AKI, acute kidney injury; BNP, brain natriuretic peptide; CKD, chronic kidney disease; COVID-19, Coronavirus Disease 2019; CRP, C reactive protein; eGFR, estimated glomerular filtration rate; HS, Troponin: high sensitivity troponin; IL-6, interleukin 6; P/F, PaO₂/FiO₂ ratio; RAS, renin angiotensin system; SARS CoV2, severe acute respiratory syndrome coronavirus 2; T2D, type 2 diabetes.

Data Sharing Statement

The datasets used and/or analysed during the current study are not publicly available due to privacy concerns. They are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

Ethical approval was obtained from the local institutional review board (Comitato Etico Area Vasta Nord Ovest, Internal Review Board). All patients provided consent for the anonymous use of data from their clinical records for scientific purposes.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.