Pharmacotherapy for Patients with Chronic Kidney Disease during the COVID-19: A Narrative Review

Abstract

Background: COVID-19 is considered the most challenging global pandemic. Patients with COVID-19 are more vulnerable to renal impairment especially those admitted to the Intensive Care Units (ICUs). Objective: In this review we discuss the epidemiology, the pathophysiology, the clinical implications and specific COVID-19 therapy in CKD patients. Results: The prevalence of CKD patients with COVID-19 varies between 0.7 to 47.6%. Patients with CKD ought to be encouraged to take extra precautions (isolation, distancing, wearing Personal Protective Equipment (PPE)) to limit the risk of exposure to the virus. Renin-Angiotensin System (RAS) and SARS-CoV-2 interactions, through the binding of the virus to ACE-2, have  produced speculations of both likely damage and advantage of RAS inhibitor use during the pandemic. Remidisivir should be avoided in CKD patients (Cr Cl<30ml/min) with COVID-19. In addition, the doses of nephrotoxic medications (chloroquine phosphate and dexamethasone) that are recommended to be used in the management of COVID-19 should be adjusted according to creatinine clearance and dialysis. Conclusion: COVID-19 may worsen the impaired kidney function and increase mortality.                Care givers should pay especial attention to medications dosing in COVID-19 patient with CKD history.