Remdesivir (Veklury) is an antiviral medication that treats several viral infections, including COVID-19. However, the research is inconclusive about its effect on kidney health.

Some experts believe that remdesivir is generally safe and effective, while others recommend against using it to treat COVID-19 due to the risk of kidney injury.

Other medications may be effective and pose a lower risk of kidney damage.

This article reviews current research into remdesivir and its potential to cause kidney damage.

A vial of remdesivir.Share on Pinterest
Pallava Bagla/Corbis via Getty Images

Remdesivir is an antiviral medication that targets the RNA in viruses to prevent replication. The Food and Drug Administration (FDA) approved the use of intravenous remdesivir to treat people with severe COVID-19. It is suitable for adults and children who are 28 days or older and weigh at least 6.6 pounds, or 3 kilograms.

In the hospital, a person takes remdesivir intravenously through a vein, in a procedure that takes 30–120 minutes. They receive the medication once per day for around 5–10 days.

Remdesivir underwent several studies and showed general effectiveness in treating COVID-19. A 2020 study of over 1,000 people hospitalized with the disease found that it safely and effectively shortened the time to recovery in adults.

Remdesivir may cause kidney failure in people with reduced kidney function. Therefore, health experts recommend testing a person’s kidney function before they start the medication. Doctors do not recommend it for individuals with kidney failure.

This precaution is due in part to how remdesivir works. Both the powdered and liquid versions of the medication contain what health experts consider safe levels of a substance known as sulfobutylether beta-cyclodextrin sodium (SBECD).

Typical kidneys can remove SBECD from the body. However, people with kidney impairment or failure may experience liver or kidney toxicity due to the release of this substance.

Additionally, research suggests a link between remdesivir and kidney failure that may lead to severe lung issues.

Learn more about kidney failure here.

In a 2020 study, researchers found that remdesivir had little or no effect on the risk of kidney damage. Other experts added that the powdered form may be safe for people with kidney issues.

Another 2021 study noted that doctors have successfully and safely treated several other viral infections with remdesivir. They did not mention the potential for kidney damage or failure linked to infections, including SARS-CoV-2, the infection that causes COVID-19.

However, several other studies point to remdesivir having potentially adverse effects on kidney health.

Researchers in a 2021 study searched the international adverse effects database of the World Health Organization (WHO) for cases of acute renal failure (ARF) in people receiving treatment with remdesivir. They also searched for cases of ARF in people taking other drugs for COVID-19. They found a significantly higher number of cases of ARF in those who received remdesivir.

Another 2021 study found similar results. They noted that, compared with other antiviral medications to treat COVID-19, remdesivir was more likely to cause kidney issues, most notably acute kidney injury.

A 2022 study noted that acute kidney injury is a potential complication of COVID-19 that could be due to the use of remdesivir. The authors highlighted the significant association between remdesivir and acute kidney injury and urged the need for more studies into its safety.

With so much conflicting research, doctors do not yet know the likelihood that a person taking remdesivir will experience kidney damage.

Find more COVID-19 information here.

People with kidney issues should avoid using remdesivir. Though some experts suggest this medication may be safe, several others do not recommend its routine use.

A person with reduced kidney function should discuss this with a doctor. Healthcare professionals can devise a treatment plan that considers the potential for damage to the kidneys.

Other antiviral medications may help treat COVID-19 and be safer for the kidneys. These medications include:

A person should discuss the potential side effects of any drug with a doctor before taking them.

Remdesivir may cause several side effects. In studies, the most common side effects have included:

A person may also experience pain, bleeding, or bruising at the injection site.

Individuals should speak with a doctor or nurse immediately if they experience the following symptoms during or after their remdesivir infusion:

  • nausea
  • vomiting
  • shivering or chills
  • dizziness upon standing up
  • rash
  • wheezing or difficulty breathing
  • unusually fast or slow heartbeat
  • swelling of the face, throat, tongue, lips, or eyes
  • yellow eyes or skin
  • dark urine
  • pain or discomfort in the right upper stomach area
  • chest pain
  • headache
  • flushing

Doctors may stop or adjust a person’s treatment if they experience any of these side effects.

Remdesivir received attention in recent years due to its use in treating COVID-19.

Several studies suggested this medication may increase the risk of kidney injury, while a few highlight its overall safety and effectiveness in treating viral infections, including the infection that leads to COVID-19.

People with existing kidney damage should not take remdesivir and should discuss any concerns with a doctor.

Other medications may be effective for treating infections and carry a reduced risk of adverse effects on the kidneys.