Comparison of safety and outcomes related to remdesivir treatment among dialysis patients hospitalized with COVID-19

Background Patients with end-stage kidney disease (ESKD) are highly susceptible to coronavirus disease 2019 (COVID-19) infection and its complications. Remdesivir has improved outcomes in COVID-19 patients but its use has been limited among ESKD patients due to insufficient data regarding safety outcomes. We sought to evaluate the safety of remdesivir among dialysis patients hospitalized with COVID-19. Methods This retrospective cohort study was conducted among patients age >= 18 years on maintenance dialysis and hospitalized with COVID-19 between 1 May 2020 and 31 January 2021 within an integrated health system who were treated or not treated with remdesivir. The primary outcome was 30-day all-cause mortality. Secondary outcomes were intensive care unit (ICU) stay, and transaminitis (AST/ALT >5x normal). Pseudo-populations were created using inverse probability of treatment weights with propensity scoring to balance patient characteristics among the two groups. Multivariable Poisson regression with robust error was performed to estimate 30-day mortality risk ratio. Results A total of 486 (407 hemodialysis and 79 peritoneal dialysis) patients were hospitalized with COVID-19, among which 112 patients (23%) were treated with remdesivir [median treatment four days (interquartile range 2-5)]. The 30-day mortality rate was 24.1% among remdesivir-treated and 27.8% among non-treated patients. The estimated 30-day mortality rate was 0.74 (95% confidence interval 0.52-1.05) among remdesivir treated compared with non-treated patients. Liver injury and ICU admission rates were 1.8% and 14.3% among remdesivir-treated patients compared with 2.4% and 16% among non-treated patients. Conclusion Among dialysis patients hospitalized with COVID-19, remdesivir was not associated with higher rates of liver injury or ICU admissions, and demonstrated a trend toward lower 30-day mortality. Lay Summary Dialysis patients are highly susceptible to coronavirus disease 2019 (COVID-19) infection, with mortality as high as 30%. Remdesivir has improved outcomes in COVID-19 patients, but its use has been limited among the dialysis population due to insufficient safety data. We evaluated the safety of remdesivir among dialysis patients hospitalized with COVID-19 by performing a retrospective cohort study among patients aged >= 18 years on maintenance dialysis within an integrated health system. Peritoneal and hemodialysis patients hospitalized with COVID-19 between 1 May 2020 and 31 January 2021 who were treated or not treated with remdesivir were observed for 30-day all-cause mortality and adverse outcomes potentially attributed to remdesivir. Our study demonstrated that remdesivir treatment in both peritoneal and hemodialysis patients hospitalized with COVID-19 was not associated with worsened liver injury, intensive care stays and mortality outcomes compared with patients who did not receive remdesivir. Furthermore, remdesivir-treated patients demonstrated a trend toward improvement in 30-day mortality.