Abstract
(1) Background: Immune compromised hemodialysis patients are more likely to develop COVID-19 infections, which increase the risk of mortality. The benefits of Remdesivir, despite less literature support on its effectiveness in dialysis patients due to renal toxicity, can outweigh the risks if prescribed early. The aim of this study was to evaluate the efficacy of Remdesivir on the 30-day in-hospital clinical outcome of hemodialysis population with COVID-19 infection and safety endpoints of adverse events. (2) Study design: A prospective quasi-experimental study design was used in the study. (3) Methods: The sample population consisted of 83 dialysis patients with COVID-19 who were administered Remdesivir at a dose of 100 mg before hemodialysis, as per hospital protocol. After the treatment with Remdesivir, we assessed the outcomes across two endpoints, namely primary (surviving vs. dying) as well as clinical and biochemical changes (ferritin, liver function test, C-reactive protein, oxygen requirements, and lactate dehydrogenase levels) and secondary (adverse effects, such as diarrhea, rise in ALT). In Kaplan–Meier analysis, the survival probabilities were compared between patients who received Remdesivir within 48 h of diagnosis and those who received it after 48 h. Cox regression analysis was employed to determine the predictors of outcome. (4) Results: Of the 83 patients, 91.5% survived and 8.4% died. Remdesivir administration did not reduce the death rate overall. Hospital stays were shorter (p = 0.03) and a nasopharyngeal swab for COVID-19 was negative earlier (p = 0.001) in survivors who had received Remdesivir within 48 h of diagnosis compared to those who had received Remdesivir after 48 h. The only variables linked to the 30-day mortality were serum CRP (p = 0.028) and TLC (p = 0.013). No major adverse consequences were observed with Remdesivir. (5) Conclusions: Remdesivir has the potential to shorten the recovery time for dialysis patients if taken within 48 h of onset of symptoms, without any adverse effects.
Highlights
Coronavirus disease 2019 (COVID-19), declared as a global pandemic by the World Health Organization on 11 March 2020, is causing widespread havoc in healthcare sectors, resulting in about 318.6 million cases and 5.5 million deaths by 17 January 2022 [1]
A review of the literature revealed that patients with comorbid conditions, such as diabetes, hypertension, and cardiovascular disease are more likely to develop a COVID-19 infection in a more severe form, requiring intensive-care unit (ICU) admission [23,24]
Considered a panacea for COVID-19, the drug was later found benign in only improving recovery times and shortening hospital stays, as evident by the two largest clinical trials conducted to date on Remdesivir, (Solidarity trial [14] and the ACTT-1 [15])
Summary
Coronavirus disease 2019 (COVID-19), declared as a global pandemic by the World Health Organization on 11 March 2020, is causing widespread havoc in healthcare sectors, resulting in about 318.6 million cases and 5.5 million deaths by 17 January 2022 [1]. COVID19 affects 3.3% of the dialysis population, which is significantly higher than 0.2% of nondialysis patients. Evidence suggests that elderly people, especially those with a compromised immune system and multiple comorbid conditions, are more likely to be affected by COVID-19 infections [3]. Earlier studies showed that patients who undergo hemodialysis are immune compromised, have multiple conditions, such as heart disease, high blood pressure, diabetes, and lung disease, and are in a crowded health-care facility, with a higher risk of infection, resulting in adverse outcomes [3,4]. An alarmingly high level of mortality (20%), as compared to the general population has been identified in COVID-19 hemodialysis patients [5]
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