Treatment Options for COVID-19 in Patients with Reduced or Absent Kidney Function

Miller-Handley, Hilary; Luckett, Keith; Govil, Amit

COVID-19, the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, was first identified in the Hubei Province of China in late 2019. Currently the only role for therapy is treatment of the disease, as opposed to post-exposure prophylaxis, however multiple clinical trials are currently ongoing for both treatment and prophylaxis. Treating COVID-19 relies on two components; the first is inhibition of the viral entrance and replication within the body and the second is inhibition of an exacerbated immune response which can be seen in patients with severe disease. Many drugs have shown in vitro antiviral activity, however clinical trials have not been as promising. Remdesivir has shown a shortening in the time to recovery in hospitalized adults, however currently no mortality benefit demonstrated. Dexamethasone has shown improved mortality in patients requiring respiratory support, but not otherwise. Current research is ongoing in immunomodulation with monoclonal antibodies including interleukin (IL)-6 receptor antagonists and Janus Kinase (JAK) inhibitors. This review summarizes the current data for the most commonly used drugs for COVID-19, and will cover the unique factors that may affect the dosing of these medications in patients with chronic kidney disease (CKD). While clinical trials are ongoing, most are in patients with normal kidney function. During a pandemic when patients with CKD are at higher risk of both infection and death, it is imperative to include patients these patients in the clinical trials.