Aiswarya Dhanapalan, Arumugam Venkatesh, Dineshkumar Thanigachalam, Gopalakrishnan Natarajan, Lamech Tanuj Moses, Nithya Govindasamy, Sastry Bhagavatula V R H, Vathsalyan Paulpandian, Dhanapriya Jeyachandran, Sakthirajan Ramanathan
Institute of Nephrology, Madras Medical College, Chennai, India.
Kidney Int Rep. 2021 Mar;6(3):586-593. doi: 10.1016/j.ekir.2020.12.003. Epub 2020 Dec 18.
There are scarce data regarding the use of remdesivir in patients with severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) and end-stage renal disease as US Food and Drug Administration cautions against its use in patients with an estimated glomerular filtration rate <30 ml/min/1.73m unless the potential benefits outweigh the potential risks. We studied the compassionate use and safety profile of remdesivir in patients with end-stage renal disease and moderate to severe SARS-CoV-2 infection.
We conducted an observational prospective study in 48 dialysis-dependent patients with SARS-CoV-2 infection who received remdesivir as part of institutional treatment protocol. During the treatment period, 100 mg of remdesivir was given 4 hours before hemodialysis sessions. Liver function tests, inflammatory markers such as serum C-reactive protein, serum ferritin and lactate dehydrogenase levels, and oxygen requirement before and after remdesivir treatment were compared.
There were no events of significant liver function test alterations with the administration of 2 to 6 doses of remdesivir. A significant decline in serum C-reactive protein level ( < 0.001) was noted. More than two thirds (68.57%) of patients showed an improvement in oxygen requirement. Early administration of remdesivir within 48 hours of hospital admission shortened the duration of hospitalization by a mean of 5.5 days ( = 0.001).
Remdesivir was well tolerated and found safe in our study. If initiated within 48 hours of hospitalization, it reduces recovery time. Assessing the mortality benefits of remdesivir in these patients requires a randomized controlled trial with a larger population.
关于瑞德西韦在严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染且患有终末期肾病患者中的应用数据稀少，因为美国食品药品监督管理局警告称，对于估计肾小球滤过率<30 ml/min/1.73m²的患者，除非潜在益处大于潜在风险，否则不建议使用该药。我们研究了瑞德西韦在终末期肾病合并中度至重度SARS-CoV-2感染患者中的同情用药情况及安全性。
我们对48例依赖透析的SARS-CoV-2感染患者进行了一项观察性前瞻性研究，这些患者接受瑞德西韦作为机构治疗方案的一部分。在治疗期间，每次血液透析前4小时给予100 mg瑞德西韦。比较了瑞德西韦治疗前后的肝功能检查、炎症指标如血清C反应蛋白、血清铁蛋白和乳酸脱氢酶水平以及氧需求情况。
给予2至6剂瑞德西韦后，未出现肝功能检查显著改变的情况。血清C反应蛋白水平显著下降（P<0.001）。超过三分之二（68.57%）的患者氧需求有所改善。入院48小时内尽早使用瑞德西韦可使住院时间平均缩短5.5天（P = 0.001）。
在我们的研究中，瑞德西韦耐受性良好且安全。如果在住院48小时内开始使用，可缩短恢复时间。评估瑞德西韦对这些患者的死亡率益处需要进行一项更大规模人群的随机对照试验。
