Pharmacological Treatment Options for Coronavirus Disease-19 in Renal Patients

Table 1

Drugs used to manage COVID-19 (alone or in combination) with their proposed dosing adjustment in different stages of chronic kidney disease and potential renal adverse events.

Drug	COVID-19 status	Normal dose (eGFR ≥90)	Dose according to different stages of renal disease					Renal adverse events
			eGFR 60–89	eGFR 30–59	eGFR <30	Dialysis	Transplant
Systemic corticosteroids
Dexamethasone	Phase III	6 mg/24 h po/iv (7–10 days) or days 1–5: 20 mg/24 h; days 6–10: 10 mg/24 h	Normal dose	Normal dose	Normal dose	Normal dose	Normal dose	Not reported
Hydrocortisone	Phases II-III	50 mg/8 h iv (7–10 days)	Normal dose	Normal dose	Normal dose	Normal dose	Normal dose	Not reported
Methyl-prednisolone	Phase III	8 mg/6 h iv (7–10 days)	Normal dose	Normal dose	Normal dose	Normal dose	16 mg followed by 8–16 mg/day	Not reported
Antivirals
Remdesivir	Phase III	200 mg/24 h iv (day 1) and then 100 mg/24 h iv (up to 5–10 days)	Normal dose	Normal dose	Avoid use	HD: may be used (100–200 mg given 4 hours prior)	Based on eGFR	Mitochondrial injury in tubular epithelial cells
						PD: N/A		SBECD-associated renal toxicity
Darunavir/cobicistat	Phase III	800 mg/150 mg/24 h po (5–14 days)	Normal dose	Normal dose	Normal dose	Normal dose	Normal dose	Cobicistat-associated false creatinine elevation
Danoprevir/ritonavir	Phase IV	100 mg/100 mg/12 h po (10–14 days)	N/A	N/A	N/A	N/A	N/A	N/A
Ribavirin	Phase II	400 mg/12 h (14 days)	Normal dose	200 mg and 400 mg every other day)	200 mg/24 h	200 mg/24 h	Based on eGFR	Not reported
Oseltamivir	Phase IV	75 mg/12 h po (5 days)	Normal dose	75 mg/24 h or 30 mg/12 h po	eGFR 10–30: 30 mg/24 h po	HD: 30 mg after each session (3x/week)	Based on eGFR	Not reported
					eGFR<10 not on dialysis: avoid the use	PD: 30 mg single dose after or 30 mg weekly
Hydroxychloroquine	Phases III-IV	Day 1: 400–600 mg/24 h po; days 2–5: 200 mg/12 h po	200 mg/12 h po	200 mg/12 h po	eGFR 15–30: 200 mg/24 h po	Normal dose (administer after dialysis)	Based on eGFR	Renal phospholipidosis
					eGFR <15: 200 mg po alternate days
Chloroquine	Phase IV	Day 1: 600 mg and then 300 mg after 12 h po; days 2–5: 300 mg/12 h po or 500 mg/12 h po (5–10 days)	Normal dose	Normal dose	eGFR >10: normal dose	Normal dose (administer after dialysis)	Based on eGFR	Renal phospholipidosis
					eGFR <10: reduce dose by 50%
Antibiotics
Azithromycin	Phase IV	500 mg/24 h po (3–5 days) or 500 mg (day 1), 250 mg/24 h (days 2–5)	Normal dose	Normal dose	Normal dose	Normal dose	Normal dose	Potential drug-induced acute interstitial nephritis
Doxycycline	Phase III	100 mg/12 h po (5 days)	Normal dose	Normal dose	Normal dose	Normal dose	Normal dose	Not reported
Monoclonal antibody agents
Bamlanivimab + etesevimab	Phase III	700 mg/1400 mg iv once	Normal dose	Normal dose	Normal dose	Normal dose	Normal dose	Not reported
Casirivimab + imdevimab	Phase III	600 mg/600 mg iv once	Normal dose	Normal dose	Normal dose	Normal dose	Normal dose	Not reported
Sotrovimab	Phase III	500 mg iv infusion once	Normal dose	Normal dose	Normal dose	Normal dose	Normal dose	Not reported
Tocilizumab	Phase III	8 mg/kg iv (max 800 mg)	Normal dose	Normal dose	Normal dose	Normal dose	Normal dose	Nephrolithiasis
Baricitinib	Phase III	4 mg/24 h po (14 days)	Normal dose	2 mg/24 h po	eGFR 15–30: 1 mg/24 h po; eGFR <15: avoid use	Avoid use	Avoid use	Acute kidney injury
Adalimumab	Phase IV	160 mg sc once	Normal dose	Normal dose	Normal dose	Normal dose	Normal dose	Granulomatous acute interstitial nephritis
Sarilumab	Phases II-III	200–400 mg iv once	Normal dose	Normal dose	Normal dose	Normal dose	Normal dose	Not reported

Dialysis includes hemodialysis and peritoneal dialysis. eGFR, estimated glomerular filtration rate; po, peroral; iv, intravenous; sc, subcutaneous.