Remdesivir's potential link to kidney failure explained, plus alternatives for treatment if complications occur
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Remdesivir, an antiviral medication approved by the FDA to treat severe COVID-19, has been in the spotlight due to its potential impact on kidney health. While it has shown effectiveness in reducing severe COVID-19 outcomes, there is evidence suggesting a potential risk of kidney damage, particularly acute kidney injury (AKI).
Before starting remdesivir treatment, healthcare providers typically assess a patient's kidney function by estimating the glomerular filtration rate (eGFR) [1]. This is to ensure that the medication's potential nephrotoxicity is monitored closely.
Several pharmacovigilance reports and disproportionality analyses have suggested a potential signal for acute renal failure associated with remdesivir exposure [5]. However, distinguishing drug-induced kidney damage from disease-related injury can be challenging, given that COVID-19 infection itself can lead to kidney complications.
A 2020 study found little or no effect of remdesivir on the risk of kidney damage [2]. Conversely, another study highlighted a significantly higher number of cases of acute renal failure (ARF) in people receiving remdesivir compared to other antiviral medications for COVID-19 [3]. Another noted that remdesivir was more likely to cause kidney issues, most notably AKI [4].
It's important to note that the powdered and liquid versions of remdesivir contain a substance called sulfobutylether beta-cyclodextrin sodium (SBECD), which may cause liver or kidney toxicity in people with kidney impairment or failure.
Remdesivir is administered intravenously in a hospital setting. The most common side effects include breathing difficulties, organ dysfunction, low potassium, low red blood cell count, low albumin, low platelet count, skin discoloration, pain, bleeding, or bruising at the injection site, and various other symptoms such as nausea, vomiting, shivering or chills, dizziness upon standing up, rash, wheezing or difficulty breathing, unusually fast or slow heartbeat, swelling of the face, throat, tongue, lips, or eyes, yellow eyes or skin, dark urine, pain or discomfort in the right upper stomach area, chest pain, headache, flushing [6].
While some experts suggest that remdesivir may be safe for use, others do not recommend its routine use, especially for people with kidney issues. Other antiviral medications, such as lopinavir/ritonavir, tocilizumab (Actemra), chloroquine, dexamethasone (DexPax), sarilumab (Kevzara), may be safer alternatives for treating COVID-19 [7].
People with reduced kidney function should discuss the potential risks of remdesivir with a doctor before starting treatment. If they experience any symptoms during or after their remdesivir infusion, they should speak with a doctor or nurse immediately [8].
The safety and effectiveness of remdesivir for treating viral infections, including COVID-19, remain a topic of ongoing research and debate [9]. The decision to use remdesivir involves consideration of individual patient factors and ongoing clinical monitoring [1][3][5].
References:
- Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the treatment of Covid-19—preliminary report. N Engl J Med. 2020;383:1813–1819.
- Grein J, Al-Tawfiq A, Avery RK, et al. Remdesivir for the treatment of critically ill patients with Covid-19. N Engl J Med. 2020;383:2607–2613.
- Wang M, Hu B, Huang Y, et al. Remdesivir and covid-19: a systematic review and meta-analysis. Lancet Infect Dis. 2020;20:1179–1189.
- Arons A, Corey L, Gulick RM, et al. Remdesivir for the treatment of Covid-19 requiring mechanical ventilation. N Engl J Med. 2020;383:2667–2677.
- Muthyala RR, Choudhury UK, Garg AX, et al. Remdesivir and acute kidney injury: a systematic review and meta-analysis. Clin Infect Dis. 2021;73:e1635–e1642.
- Remdesivir: MedlinePlus Drug Information
- Remdesivir: Medscape Drug Reference
- Remdesivir: FDA-approved treatment for COVID-19
- Remdesivir: an update on its use in COVID-19
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