((SLC-041)) (SLC-041) Remdesivir and Renal Outcomes in Hospitalized COVID-19 Patients Without Severe Renal Impairment: A Retrospective Cohort Study

Background: Remdesivir has been shown to reduce mortality and slow disease progression in patients with COVID-19. However, conflicting results have been reported regarding the effect of remdesivir on kidney function.

Objectives: This study aims to address these conflicting findings by utilizing advanced causal inference methods and real-world data to assess the relationship between remdesivir use and renal outcomes.

Methods: We conducted a retrospective cohort study using Optum's de-identified Clinformatics® Data Mart Database. Patients hospitalized for COVID-19 without severe renal impairment were included. Each remdesivir user who was exposed to at least one dose of remdesivir was matched to up to 4 nonusers based on the time of hospitalization. Exposure to remdesivir was modelled as a daily time-varying variable. The primary outcome was experiencing acute kidney injury (AKI) within 14 days. The secondary outcome was defined as a composite outcome of renal adverse events (RAEs) within 14 days, which included AKI, renal replacement therapy, and death. Marginal structural models with inverse probability of treatment weighting were applied to account for baseline and time-varying covariates. Cumulative risk differences and variations in restricted mean survival time were calculated to compare 10 consecutive days of remdesivir use versus no use.

Results: After matching, a total of 6603 patients were included (2,768 remdesivir users; 3,835 nonusers). There was no significant difference in the risk of AKI (risk difference: -2.44%, 95% CI: -8.06% to 3.13%) or RAEs (risk difference: -0.71%, 95% CI: -7.34% to 5.79%). There was also no significant difference in restricted mean survival times comparing remdesivir users to nonusers (AKI: 0.23 days, 95% CI: -0.22 to 0.68; RAEs: 0.13 days, 95% CI: -0.40 to 0.67).

Conclusions: In hospitalized COVID-19 patients without severe renal impairment, remdesivir use was not associated with increased or reduced risk of RAEs. These findings support the renal safety of remdesivir in this population, but further studies are needed in patients with severe renal impairment.