The impact of remdesivir on renal and liver functions remains a matter of concern in advanced COVID-19 patients with high illness severity and presence of viral load. The laboratory results of the 114 patients (males 55.8%, age 71 (59; 77) years) with a detectable viral load treated with remdesivir were compared with the controls. Baseline plasmatic creatinine (PCr) < 150 µmol/l in patients on remdesivir decreased equally to controls (- 6 (- 20; 9) vs. - 8 (- 24; 2) µmol/l, n = 170, p = 0.11). The similar trends were found for baseline PCr ≥ 150 µmol/l (- 57 (- 129; - 15) µmol/l for remdesivir group vs. - 65 (- 111; - 7) µmol/l, p > 0.9). Changes of PCr were independent of the remdesivir therapy, the statistically significant confounders were baseline PCr levels (p < 0.001), hospital length-of-stay (p < 0.001), leukocyte-to-lymphocyte ratio (p = 0.025). The plasmatic urea (PU) mildly increased in the remdesivir group (1 (- 2; 5) mmol/l vs. 0 (- 3; 2) mmol/l in the controls, p = 0.009), its levels were related to remdesivir (p = 0.026), age (p = 0.002), PCr (p < 0.001), hospital length-of-stay (p < 0.001), IPPV (p = 0.035). Regarding the liver function tests the significant relationships to remdesivir therapy were found only for GGT (p = 0.007) and ALT (p = 0.044). The levels of PCr were decreasing over the hospitalisation period including patients with mild-to-moderate renal insufficiency. The multivariate regression analysis excluded an impact of remdesivir on the PCr changes yet admitted an impact on the levels of urea, GGT and ALT.

Department of Anaesthesiology and Intensive Care 1st Faculty of Medicine Charles University and General University Hospital U Nemocnice 2 12800 Prague 2 Czech Republic

Department of Anaesthesiology and Intensive Care 3rd Faculty of Medicine Charles University and Kralovske Vinohrady University Hospital Prague Czech Republic

Department of Laboratory Diagnostics 3rd Faculty of Medicine Charles University and Kralovske Vinohrady University Hospital Prague Czech Republic

Department of Microbiology Faculty of Medicine and Dentistry Palacky University Olomouc Czech Republic

Institute of Health Information and Statistics of the Czech Republic Faculty of Medicine Masaryk University Brno Czech Republic

Institute of Medical Biochemistry and Laboratory Diagnostics 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

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