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Abstract: PO0153

Comparison of Safety and Outcomes Related to Remdesivir Use Among Dialysis Patients Hospitalized with COVID-19

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Zaki, Kirollos Emad, Kaiser Permanente Southern California, Los Angeles, California, United States
  • Huang, Cheng-Wei, Kaiser Permanente Southern California, Los Angeles, California, United States
  • Zhou, Hui, Kaiser Permanente Southern California, Los Angeles, California, United States
  • Chung, Joanie, Kaiser Permanente Southern California, Los Angeles, California, United States
  • Selevan, David C., Kaiser Permanente Southern California, Los Angeles, California, United States
  • Rutkowski, Mark P., Kaiser Permanente Southern California, Los Angeles, California, United States
  • Sim, John J., Kaiser Permanente Southern California, Los Angeles, California, United States
Background

Use of remdesivir in the treatment of dialysis patients with Coronavirus Disease 2019 (COVID-19) has been limited due to inconclusive data regarding safety outcomes among patients with severe renal impairment. For this reason, the FDA has not recommended remdesivir use in patients with eGFR < 30 ml/min per 1.73 m2. We sought to evaluate outcomes among dialysis patients with COVID-19 who received remdesivir in a real-world setting.

Methods

We conducted a retrospective study of patients on hemodialysis or peritoneal dialysis hospitalized with COVID-19 between 5/1/2020 - 1/31/2021 within the integrated health system of Kaiser Permanente Southern California. Patients with a COVID-19 International Classification of Diseases (ICD)-10 code: U07.1 and laboratory confirmed SARS-CoV-2 infection within 14 days prior to admission date to two days after admission date were included. The primary endpoint was 30-day all-cause mortality. Secondary endpoints were intensive care unit (ICU) stay, and evidence of acute liver injury defined as AST and/or ALT values >5x upper limit of normal.

Results

A total of 486 patients (407 hemodialysis and 79 peritoneal dialysis) met inclusion criteria. Among those, 112 patients (23%) were treated with remdesivir, with median treatment time of 4 days (IQR: 2-5). Mean age was 63.8 years with 63.8% male and 63.0% Hispanic patients. There were 80.2% of patients who received treatment with steroids during hospitalization. Relative risk (RR) for all-cause 30-day mortality was 0.74 (95% CI: 0.52-1.05) in remdesivir treated patients compared to untreated patients. Acute liver injury occurred in 1.8% and 2.4% of remdesivir treated and untreated patients, respectively. ICU admissions occurred in 14.3% of remdesivir treated and 16% of untreated patients.

Conclusion

Among dialysis patients hospitalized with COVID-19, treatment with remdesivir was not associated with worse outcomes in terms of liver injury or ICU admission, and demonstrated a trend (26% lower risk) toward decrease in 30-day mortality, though no statistical significance was found due to insufficient power.