Table 1: Summary of current COVID-19 therapies, benefits, and considerations in patients with CKD stage 4-5 and patients on dialysis.



Considerations in CKD


Decreased hospital stays

Fairly likely tolerated with increased monitoring for accumulation or undertreatment


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


Improved outcomes in COVID-induced AKI

No adjustments needed or special considerations


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


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