Remdesivir and Renal Outcomes in Hospitalized COVID-19 Patients Without Severe Renal Impairment: A Retrospective Cohort Study

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BACKGROUND: Remdesivir has demonstrated effect in reducing COVID-19 mortality and disease progression, while conflicting associations have been reported between remdesivir and renal outcomes. OBJECTIVE: This study leverages an advanced causal inference tool and real-world data to address this question in hospitalized COVID-19 patients without severe renal impairment. METHODS: Data Mart Database. Each hospitalized COVID-19 patient without severe renal impairment who used remdesivir was matched to up to 4 nonusers based on hospitalization time. The primary outcome was acute kidney injury (AKI) within 14 days, while the secondary outcome, renal adverse events (RAEs), included AKI, renal replacement therapy, and death within 14 days. Marginal structural models were used to estimate cumulative risk differences and differences in restricted mean survival time comparing 10 consecutive days of remdesivir use to nonuse. RESULTS: The matched cohort included 2768 remdesivir users and 3835 nonusers. No significant differences were found in the risk of AKI (risk difference: -2.44%, 95% confidence interval CI -8.06% to 3.13%) or RAEs (risk difference: -0.71%, 95% CI -7.34% to 5.79%). Restricted mean survival time also showed no significant differences between remdesivir users and nonusers for AKI (0.23 days, 95% CI -0.22 to 0.68) or RAEs (0.13 days, 95% CI -0.40 to 0.67). CONCLUSION AND RELEVANCE: Remdesivir use was not associated with increased or reduced risk of RAEs in hospitalized COVID-19 patients without severe renal impairment, thereby supporting its continued clinical use as a safe antiviral without offering additional renal benefit.

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