Ito Jun, Kimura Moritsugu, Toya Tomoyuki, Isozumi Konomi, Kawaji Atsuro, Isozaki Yudai, Fukagawa Masafumi
Kidney Center, Division of Nephrology and Diabetes, Tokai University Oiso Hospital, 21-1, Gakkyo, Oiso, Naka-gun, Kanagawa 259-0198 Japan.
Division of Nephrology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa 259-1193 Japan.
Ren Replace Ther. 2022;8(1):14. doi: 10.1186/s41100-022-00404-9. Epub 2022 Apr 11.
The mortality rate of novel coronaviral disease (COVID-19) patients undergoing dialysis is considerably higher than that of patients with normal kidney function. As of August 2021, only remdesivir has been approved in Japan as an antiviral drug for the treatment of COVID-19. However, in cases of kidney failure, remdesivir administration should be considered only if the therapeutic benefits outweigh the risks because of concern about the accumulation of its solubilizing excipient sulfobutylether-beta-cyclodextrin and subsequent renal tubular injury or liver injury. Recently, reports from overseas indicating the safety of the use of remdesivir for COVID-19 patients on dialysis have been gathered.
From June 2021, in our hospital, we started the administration of remdesivir to patients with moderate cases of COVID-19 undergoing hemodialysis, with careful consideration of the dosage and timing. Since then, six out of seven COVID-19 patients on hemodialysis who had received remdesivir have completely recovered. In a patient who died, the initial dose of remdesivir was administered after the case developed into severe COVID-19. All six patients who were able to start receiving remdesivir immediately at the stage of moderate COVID-19 recovered and were discharged without the need for mechanical ventilation. While, two out of four patients before May 2021 who had not been administered remdesivir at admission became severe, transferred to another tertiary hospital, and died. During and after remdesivir administration, no increase in serum transaminase to five times or more of the normal upper limit was observed in any of the cases. There were no other adverse drug reactions, such as infusion reaction, gastrointestinal symptoms, or anemia.
We were able to administer remdesivir to six Japanese patients with moderate COVID-19 on hemodialysis safely. It is expected that the safe use of remdesivir will bring an increase in treatment options for moderate cases of COVID-19 in dialysis patients as well as subsequent improvement in treatment outcomes. However, to confirm the efficacy and safety of such use, further careful observation in more cases is required.
接受透析的新型冠状病毒病（COVID-19）患者的死亡率显著高于肾功能正常的患者。截至2021年8月，在日本仅有瑞德西韦被批准作为治疗COVID-19的抗病毒药物。然而，在肾衰竭病例中，由于担心其增溶辅料磺丁基醚-β-环糊精的蓄积以及随后的肾小管损伤或肝损伤，仅在治疗益处大于风险时才应考虑使用瑞德西韦。最近，已收集到来自海外的关于在透析的COVID-19患者中使用瑞德西韦安全性的报告。
自2021年6月起，在我们医院，我们开始对接受血液透析的中度COVID-19患者使用瑞德西韦，并仔细考虑剂量和时机。从那时起，接受瑞德西韦治疗的7例血液透析COVID-19患者中有6例已完全康复。在1例死亡患者中，瑞德西韦的初始剂量是在病例发展为重症COVID-19后给予的。所有6例在中度COVID-19阶段能够立即开始接受瑞德西韦治疗的患者均康复且无需机械通气即可出院。而在2021年5月之前入院时未接受瑞德西韦治疗的4例患者中有2例病情加重，转至另一家三级医院并死亡。在瑞德西韦给药期间及之后，所有病例均未观察到血清转氨酶升高至正常上限的5倍或更高。也没有出现其他药物不良反应，如输液反应、胃肠道症状或贫血。
我们能够安全地为6例接受血液透析的中度COVID-19日本患者使用瑞德西韦。预计瑞德西韦的安全使用将增加透析患者中度COVID-19病例的治疗选择，并随后改善治疗结果。然而，为了确认这种使用的疗效和安全性，需要在更多病例中进行进一步仔细观察。
