Paxlovid for hospitalized COVID-19 patients with chronic kidney disease

• Published in: Antiviral research Vol. 216; p. 105659
• Main Authors: Cai, Hong, Yan, Jiayi, Liu, Shang, Li, Ping, Ding, Li, Zhan, Yaping, Lu, Jiayue, Li, Zhenyuan, Sun, Yiwen, Zhu, Mingli, Gao, Yuan, Gong, Xingrong, Ban, Haiqun, Gu, Leyi, Zhou, Weibin, Wang, Jieying, Mou, Shan
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-08-2023; Published by Elsevier B.V
• Subjects: Adult; All-cause death; Chronic kidney disease; COVID-19; COVID-19 - complications; Humans; Paxlovid; Renal Insufficiency, Chronic - complications; Retrospective Studies; Risk Factors; Viral elimination; COVID-19; Viral elimination; Paxlovid; Chronic kidney disease; All-cause death
• ISSN: 0166-3542; 1872-9096
• DOI: 10.1016/j.antiviral.2023.105659

COVID-19 causes significant mortality during the recent pandemic. Data regarding the effectiveness of Paxlovid on COVID-19 patients with chronic kidney disease (CKD, eGFR <90 ml/min) are limited.
A retrospective cohort study was performed on the clinical data of the hospitalized adult patients with confirmed COVID-19 infection collected at Renji Hospital from April 7, 2022 to June 21, 2022. The association of Paxlovid treatment with early (within 5 days post diagnosis) or late (5 days or later post diagnosis) initiation time with clinical outcomes was assessed by Cox proportional hazards regression model with time-dependent covariates.
1279 of 2387 enrollees were included in the study. Patients with early initiation of Paxlovid had a lower all-cause death rate compared to those with late initiation or without Paxlovid treatment (P = 0.046). For the CKD patients with Charlson comorbidity index (CCI) > 7, the early initiation of Paxlovid was associated with a lower all-cause death rate compared to the later initiation or the lack of Paxlovid treatment (P = 0.041). Cox regression analyses revealed that eGFR (HR 4.21 [95%, CI 1.62–10.99]), Paxlovid treatment (0.32 [0.13–0.77]), CCI (4.32 [1.64–11.40]), ICU admission (2.65 [1.09–6.49]), hsCRP (3.88 [1.46–7.80]), chronic liver disease (4.02 [1.09–14.85]) were the independent risk factors for all-cause death for CKD patients after adjusting for demographics and biochemical indexes.
All-cause death, invasive ventilation, and ICU admission were all significantly lowered by an early initiation of Paxlovid treatment in COVID-19 patients with severe CKD.
•The Viral load decreased faster in patients with eGFR<90 ml/min who received Paxlovid treatment≤5 days.•All-cause death was lower by taking Paxlovid in severe COVID-19 patients with chronic kidney disease.•eGFR, Paxlovid treatment were the independent risk factors for all-cause death in patients with eGFR<90 ml/min.