Safety evaluation of remdesivir administration in patients with severe renal impairment and coronavirus disease: a systematic review and meta-analysis.

Background: We conducted a comprehensive systematic review and meta-analysis to evaluate whether remdesivir (RDV) is safe for patients with severe renal impairment (SRI) and COVID-19, compared to non-SRI patients or those not receiving RDV.

Methods: This study was conducted according to the PRISMA guidelines for reporting systematic reviews and meta-analyses. We searched PubMed, Cohcrane, CINAHL, and Ichushi databases up to October 11, 2024. The outcomes assessed kidney injury, hepatic disorder and mortality. Randomized controlled trials and retrospective and cohort studies reporting kidney injury, hepatotoxicity, and mortality in (i) SRI patients treated with RDV versus without RDV or (ii) SRI patients versus non-SRI patients treated with RDV were included. Targeted patients were defined as adults with COVID-19 based on a positive reverse transcription polymerase chain reaction or rapid antigen test for SARS-CoV-2 from nasopharyngeal or salivary swabs regardless of symptoms.

Results: One randomized controlled trial and 14 cohort studies met the inclusion criteria and were included in the final meta-analysis. Among SRI patients, RDV significantly reduced the incidence of kidney injury (risk ratio [RR] = 0.51, 95% confidence interval [CI] = 0.27-0.97) but had no significant difference in the development of hepatic disorder (RR = 0.88, 95% CI = 0.39-1.98) and mortality (RR = 0.79, 95% CI = 0.55-1.15). In the comparison between SRI and non-SRI patients treated with RDV, SRI patients demonstrated a significantly higher incidence of kidney injury (odds ratio [OR] = 2.51, 95% CI = 1.49-4.23), with no significant difference in the development of hepatic disorder (OR = 1.04, 95% CI = 0.43-2.53). Meanwhile, SRI patients treated with RDV exhibited significantly higher mortality than non-SRI patients treated with RDV (OR = 2.20, 95% CI = 1.51-3.22).

Conclusion: Our meta-analysis demonstrated that RDV administration in SRI patients with COVID-19 was safe compared to non-SRI or SRI patient treated without RDV. We suggest that the use of RDV should be actively considered for SRI patients.