Table 1: Summary of current COVID-19 therapies, benefits, and considerations in patients with CKD stage 4-5 and patients on dialysis.
Therapy |
Benefit |
Considerations in CKD |
Remdesivir |
Decreased hospital stays |
Fairly likely tolerated with increased monitoring for accumulation or undertreatment |
Corticosteroids |
Decreased systemic organ damage and inflammation |
No adjustments needed or special considerations |
Immune based therapies |
Decreased disease progression requiring hospitalization |
Rare AKI reported; increase monitoring of creatinine |
Vitamin C |
Anti-oxidant effects |
Renally cleared; patients with CKD stage 4-5 and patients not on dialysis are currently not recommended to take in more than 100 mg of vitamin C daily due to the risk of oxalate accumulation and potential resultant nephropathy |
Vitamin D |
Increased calcium absorption in the gut and decreased infection rates |
Well tolerated; check vitamin D level before initiating therapy |
Niacinamide |
Improved outcomes in COVID-induced AKI |
No adjustments needed or special considerations |
Zinc |
Potential to decrease incidence of infection, decrease inflammation, and decreased oxidative stress in elderly patients |
Circulating zinc levels are commonly lower in CKD patients; check levels and only supplement if levels are low in all patients |
Blood derived products/passive antibody therapy |
Improved survival post-infection. |
There is no current evidence that passive antibody therapy is contraindicated in patients with CKD stage 4, though more specific research does need to be done |
COVID-19 vaccines |
Important in prevention of infection and spread of COVID-19 |
Recommended, though need more research specifically involving patients with CKD stage 4-5 |
Anti-coagulation |
Decreased DVT/PE risk |
Patients with CKD stages 1-3 should be given direct oral anticoagulants or heparin which do not require any dose adjustments. In patients with CKD stage 4, the dosages of these direct oral anticoagulants need to be adjusted and in CKD stage 5 and patients on dialysis, warfarin is the preferred anticoagulant |