ArticleAmerican journal of kidney diseases : the official journal of the National Kidney Foundation2025
Safety and Effectiveness of Nirmatrelvir-Ritonavir in Patients With Advanced Kidney Dysfunction and COVID-19.
Article in American journal of kidney diseases : the official journal of the National Kidney Foundation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed.
- Cardiovascular Risks of COVID-19 Therapeutics: Integrated Analysis of FAERS, Electronic Health Records, and Transcriptomics.Pharmaceuticals (Basel, Switzerland) · 2026Article
- Effectiveness of Antivirals Nirmatrelvir-Ritonavir and Molnupiravir in Viral Sepsis: Retrospective Cohort Study.JMIR public health and surveillance · 2025Article
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Authors and funding
7 authors.
Funding
Abstract
RATIONALE &
objectiveNirmatrelvir-ritonavir prevents COVID-19 hospitalization among high-risk adults, but safety concerns limit its use in advanced kidney dysfunction. This study examined safety and effectiveness outcomes from its off-label use in patients with advanced kidney dysfunction. STUDY
designRetrospective matched cohort study. SETTING &
participantsPatients with estimated glomerular filtration rate (eGFR) 15-30mL/min/1.73m EXPOSURE: Treatment with nirmatrelvir-ritonavir, no treatment with nirmatrelvir-ritonavir or molnupiravir, or treatment with molnupiravir. OUTCOME: Incidence of cardiac events, stroke, acute kidney injury, liver injury, hypertension, and infection-related death, respiratory failure, pneumonia, severe infection, and hospitalization within 30-60 days of diagnosis with COVID-19. ANALYTICAL APPROACH: Logistic regression for propensity matching, standardized mean differences for assessment of covariate balance, and conditional logistic regression for estimation of relative risk ratios comparing exposures for each outcome.
resultsAmong 4,020 patients with an eGFR of 15-30mL/min/1.73m LIMITATIONS: Retrospective analysis, predominantly men in the study cohort.
conclusionsNirmatrelvir-ritonavir use in the setting of advanced kidney dysfunction was associated with a reduced risk of acute respiratory failure and pneumonia and no detectable differences in non-respiratory adverse outcomes compared with no treatment with either nirmatrelvir-ritonavir or molnupiravir. PLAIN-LANGUAGE SUMMARY: COVID-19 can cause severe complications in patients with advanced kidney disease, yet nirmatrelvir-ritonavir, one of the first-line antiviral therapies, is not recommended in such patients due to safety concerns. We examined its safety and effectiveness among patients with advanced (stage IV) kidney disease. Using Veterans Health Administration records, we compared patients who received nirmatrelvir-ritonavir with those who were not treated with it nor with molnupiravir (a second-line therapy). We also compared treatment with nirmatrelvir-ritonavir with treatment with molnupiravir. We found that nirmatrelvir-ritonavir was associated with a reduced risk of serious lung problems without any evidence of increased risks of heart, liver, or kidney problems compared with not being treated with nirmatrelvir-ritonavir nor molnupiravir. The effectiveness and safety of nirmatrelvir-ritonavir were similar to that of molnupiravir. This study provides real-world evidence supporting nirmatrelvir-ritonavir use for patients with advanced kidney disease.
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