Safety Profile of COVID-19 Medication in Patients with CKD: Renal and Hepatic Dysfunction Associated with Antiviral and Tocilizumab Use, a Single-Centre Experience

Background: Coronavirus-19 disease is associated with increased morbidity and mortality in chronic kidney disease (CKD) patients. Choosing appropriate therapy for COVID-19 patients with impaired renal functions is challenging, as insufficient, and contradictory data is available about their dosage, frequency and safety in CKD patients. Methods: We conducted a retrospective study on 1425 COVID-19-infected patients, who received anti-viral therapy, i.e., Favipiravir, lopinavir-Ritonavir, Remdesivir and tocilizumab. Study aimed to report renal and hepatic dysfunction associated with anti-viral therapy and tocilizumab, as well as to compare drug adverse events between CKD and Non-CKD patients, to identify safety profile of these medications in CKD patients. Results: Among 1425 COVID-19-infected patients, Favipiravir, lopinavir-ritonavir and remdesivir were used in 75.15%, 15.29% and 13.19% patients respectively, while 25.89% were treated with Tocilizumab. The incidence of renal function deterioration was 18.24%, while an increase in ALT and AST was noted in 34.24% and 23.78%. Patients with GFR<60 ml/min were 15.57% and 74-patients were on hemodialysis. In CKD population, 86.93%, 28.37%, 8.10% and 22.07% were treated with Favipiravir, lopinavir-ritonavir, remdesivir, and Tocilizumab respectively. 37.83%of patients had acute on CKD, while 35.13% and 31.98% had increase in ALT and AST. Incidence of acute renal function deterioration and increase in AST were significantly higher in CKD population. In patients treated with Favipiravir, renal deterioration was significantly more in CKD patients (p=<0.05), while an increase in ALT and AST was not significant in the two groups. In patients treated with Lopinavir, remdesivir and tocilizumab, incidence of renal deterioration and increase in ALT and AST levels were not significant between two groups. Conclusion: CKD patients had a significantly higher incidence of renal function deterioration and an increase in AST. Nevertheless, these abnormal lab parameters must be considered with other risk factors, associated with severe covid-19-infection, thus COVID medicine shouldn't be denied to CKD patients