Utilizing remdesivir to treat novel coronavirus disease 2019 (SARS-CoV-2) in a patient with acute renal failure on hemodialysis: A case report

Introduction: On May 1, 2020, the US Food and Drug Administration issued an emergency use authorization to permit the use of remdesivir for treatment of adults and children hospitalized with severe SARSCoV- 2 Severe SARS-CoV-2 infection leads to an acute kidney injury in up to 20-40% of critically ill patients Patients with severe acute renal failure on hemodialysis were excluded from remdesivir trials;as a result, these patients may not be considered for treatment Case: A 63-year-old African American male with past medical history of diabetes, hypertension, and vertigo presented with flu-like symptoms and shortness of breath He was found to be SARS-CoV-2 positive On arrival he developed acute respiratory distress syndrome and required intubation Chest x-ray showed bilateral pulmonary opacities The patient was diagnosed with acute renal failure with a BUN of 89 mg/dL, SCr of 7 8 mg/dL and CrCl of 12 ml/min on admission The patient received hemodialysis daily until hospitalization day 9, and thereafter on Monday, Wednesday, Friday The remdesivir loading dose was given on hospitalization day 7 and treatment was typically administered after dialysis, for a total of 5 days The patient's liver function tests remained within normal limits, AST ranged from 24-28 IU/L and ALT ranged from 23-24 IU/L, throughout the full course of therapy Discussion: Current literature dismisses the use of remdesivir in patients with a CrCl less than 30 ml/min Concerns about the drug's potential toxicity in patients with kidney disease relates to the renal elimination and the potential accumulation of its sulfobutyletherbeta- cyclodextrin (SBECD) carrier, causing liver necrosis The absence of liver function decline in this patient suggests remdesivir, a potentially beneficial agent, may be considered safe when scheduled after hemodialysis Conclusion: Remdesivir appears to be safe in patients with acute or chronic renal disease on hemodialysis Daily liver function tests should be performed in this patient population