The efficacy of favipiravir treatment in hemodialysis patients with COVID 19

Corona Virus 2 (SARS-CoV 2), a recent coronavirus was first discovered in Wuhan, China in December 2019 [1]. Previous coronavirus infections, namely Middle-East Respiratory Syndrome (MERS-CoV ) and SARS-CoV have been reported to damage the respiratory system and cause serious outbreaks [2]. Major complaints are shortness of breath, cough, fever, and diarrhea [3,4]. Lung involvement is the most common form of infection, and is characterized by bilateral lung infiltrates [5,6]. The infection leads to cytokine storm and organ dysfunction and may consequently death. The diagnosis is suspected in presence of contact history, respiratory symptoms, fever, chest radiology, and biochemical parameters. The diagnosis is confirmed with Reverse Transcription-Polymerase Chain Reaction (RT PCR) positivity for COVID-19 in the nasopharyngeal swab [7]. It has been reported that elderly patients are more prone to severe coronavirus disease, just as in hemodialysis patients with additional comorbidities [5]. Since the immune system is low in Chronic Kidney Disease (CKD) patients, their tendency to infections is increased [8,9]. Good supportive treatment and infection treatment should be done [10]. CKD is also associated with an increased risk for pneumonia. Mortality rates related to lung infection in CKD seem to be 15-16 times higher than in the general population [9,11]. The use of several antiviral drugs, such as chloroquine phosphate, lopinavir/ritonavir, interferonalpha, ribavirin has been studied, and some clinical trials focusing on virus RNA dependent RNA Polymerase (RdRp) inhibitors have been initiated. Favipiravir, a purine-nucleic acid analog and RdRp inhibitor which has been approved for use in influenza, is also considered in clinical trials [12,13]. The data on dialysis-dependent patients with COVID-19 are limited, and recommendations are based on expert opinion and case series. There are no studies about the use of favipiravir in patients with renal failure in the literature. In this study, we aimed to describe our experience of favipiravir treatment in dialysis-dependent patients.