Is remdesivir safe in patients with renal impairment? Experience at a large tertiary urban medical center

Purpose Remdesivir is FDA-approved for treatment of patients hospitalized with COVID-19 pneumonia, but not recommended in patients with severe renal failure. This study aims to evaluate the safety of remdesivir in this patient population. Methods This was a single-center, retrospective cohort study including patients >= 18 years old, admitted between May 1, 2020 and April 30, 2021 who received remdesivir. Patients were divided into two groups: estimated creatinine clearance (eCrCl) < 30 mL/min and eCrCl >= 30 ml/min. Primary outcomes were development of acute kidney injury (AKI) after remdesivir initiation and hepatotoxicity (alanine aminotransferase [ALT] or aspartate aminotransferase [AST] > 5 x upper limit of normal) both at end of treatment (EOT) or 5 days after EOT. Secondary outcomes were length of stay (days) and mortality. Results 513 patients were assessed with 416 patients included in the study (eCrCl < 30 mL/min, n = 55; eCrCl >= 30 mL/min n = 361). Incidence of AKI (eCrCl < 30 mL/min 11% vs eCrCl >= 30 mL/min 7%, OR 1.57, 95% CI 0.57, 4.3) and hepatotoxicity (ALT: 2% vs 4%, OR 0.47, 95% CI 0.05, 3.7 and AST: 2% vs 2%, OR 1.26, 95% CI 0.14, 11.04) were similar between the two groups. Length of stay was longer in the eCrCl < 30 mL/min group (mean 18.6 vs 11.9, difference 6.7, 95% CI 3.8, 9.6), and no difference in mortality was observed (21.8% vs 18.8%, OR 1.2, 95% CI 0.6, 2.4). Conclusion Remdesivir was not associated with development of AKI or hepatotoxicity in patients with eCrCl < 30 mL/min compared to patients with eCrCl >= 30 mL/min, and warrants further investigation.