Effectiveness of molnupiravir and nirmatrelvir–ritonavir in CKD patients with COVID-19.
Franco Wing Tak Cheng, Vincent Ka Chun Yan, Eric Yuk Fai Wan, Celine Sze Ling Chui, Francisco Tsz Tsun Lai, Carlos King Ho Wong, Xue Li, Irene Ran Zhang, Sydney Chi Wai Tang, Ian Chi Kei Wong, Esther Wai Yin Chan
Kidney International Reports, doi:10.1016/j.ekir.2024.02.009
Introduction Even with effective vaccines, patients with CKD have a higher risk of hospitalization and death subsequent to COVID-19 infection compared with those without CKD. Molnupiravir and nirmatrelvir-ritonavir have been approved for emergency use, but their effectiveness for the CKD population is still unknown. This study was conducted to determine the effectiveness of these drugs in reducing mortality and severe COVID-19 in the CKD population. Methods This was a target trial emulation study using electronic health databases in Hong Kong. Patients with CKD aged 18 years or older who were hospitalized with COVID-19 were included. The per-protocol average treatment effect among COVID-19 oral antiviral initiators, including all-cause mortality, ICU admission, and ventilatory support within 28 days, were compared to non-initiators.
Results Antivirals have been found to lower the risk of all-cause mortality, with molnupiravir at a hazard ratio (HR) of 0.85 [95% CI, 0.77 to 0.95] and nirmatrelvir-ritonavir at an HR of 0.78 [CI, 0.60 to 1.00]. However, they do not significantly reduce the risk of ICU admission (molnupiravir: HR, 0.88 [CI, 0.59 to 1.30]; nirmatrelvir-ritonavir: HR, 0.86 [CI, 0.56 to 1.32]) or ventilatory support (molnupiravir: HR, 1.00 [CI, 0.76 to 1.33]; nirmatrelvir-ritonavir: HR, 1.01 [CI, 0.74 to 1.37]). There was a greater risk reduction in males and those with higher Charlson Comorbidity Index. The nirmatrelvir-ritonavir trial also showed reduced risk for those who had antiviral treatment and received three or more vaccine doses.
Conclusion Both molnupiravir and nirmatrelvir-ritonavir reduced mortality rates for hospitalized COVID-19 patients with CKD.
Supplementary Material STROBE statement (PDF) Supplementary Table S1 Target trial specification and emulation using observational data (PDF) Supplementary Table S2 . Baseline and post-assignment covariates for the construction of inverse probability weights (PDF) Supplementary Table S3 . Survival Probability for Outcomes in COVID-19 Oral Antiviral Initiators Compared With Non-initiators (PDF) Supplementary information is available at KI Report's website. J o u r n a l P r e -p r o o f
References
Agostino, Lee, Belanger, Cupples, Anderson et al., Relation of pooled logistic regression to time dependent Cox regression analysis: the Framingham Heart Study, Stat Med
Arribas, Bhagani, Lobo, Randomized Trial of Molnupiravir or Placebo in Patients Hospitalized with Covid-19, NEJM Evidence
Bernal, Da Silva, Musungaie, Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients, N Engl J Med
Carr, Kronbichler, Graham-Brown, Review of Early Immune Response to SARS-CoV-2 Vaccination Among Patients With CKD, Kidney Int Rep
Cheng, Fan, Wong, The effectiveness and safety of mRNA (BNT162b2) and inactivated (CoronaVac) COVID-19 vaccines among individuals with chronic kidney diseases, Kidney Int
Cheng, Wong, Qin, Risk of glomerular diseases, proteinuria and hematuria following mRNA (BNT162b2) and inactivated (CoronaVac) SARS-CoV-2 vaccines, Nephrol Dial Transplant
Cho, Harden, Moreno, Oral antiviral therapies for COVID-19 in patients with advanced chronic kidney disease or kidney failure, Nephrol Dial Transplant
Chua, Kwan, Chui, Epidemiology of Acute Myocarditis/Pericarditis in Hong Kong Adolescents Following Comirnaty Vaccination, Clin Infect Dis
Chui, Wan, Thromboembolic events and hemorrhagic stroke after mRNA (BNT162b2) and inactivated (CoronaVac) covid-19 vaccination: a self-controlled case series study
Flythe, Assimon, Tugman, Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States, Am J Kidney Dis
Hammond, Leister-Tebbe, Gardner, Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19, N Engl J Med
Harrison, Fazio-Eynullayeva, Lane, Underhill, Lip, Comorbidities associated with mortality in 31,461 adults with COVID-19 in the United States: A federated electronic medical record analysis, PLoS medicine
Hernán, Brumback, Robins, Marginal structural models to estimate the causal effect of zidovudine on the survival of HIV-positive men, Epidemiology
Hernán, Methods of Public Health Research -Strengthening Causal Inference from Observational Data, New England Journal of Medicine
Hernán, Robins, Using Big Data to Emulate a Target Trial When a Randomized Trial Is Not Available, Am J Epidemiol
J O U R N A L P R E, None
Kale, Shelke, Dagar, Anders, Gaikwad, How to use COVID-19 antiviral drugs in patients with chronic kidney disease, Front Pharmacol
Khan, Khan, Mustagir, Rana, Islam et al., Effects of underlying morbidities on the occurrence of deaths in COVID-19 patients: A systematic review and meta-analysis, J Glob Health
Kragholm, Andersen, Gerds, Association Between Male Sex and Outcomes of Coronavirus Disease 2019 (COVID-19)-A Danish Nationwide, Registerbased Study, Clin Infect Dis
Lai, Li, Peng, Carditis After COVID-19 Vaccination With a Messenger RNA Vaccine and an Inactivated Virus Vaccine : A Case-Control Study, Ann Intern Med
Lawrence, Mirchandani, Hill, Evaluation of publication bias for 12 clinical trials of molnupiravir to treat SARS-CoV-2 infection in 13,694 patients
Peckham, De Gruijter, Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission, Nat Commun
Petrilli, Jones, Yang, Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study, BMJ
Planas, Saunders, Maes, Considerable escape of SARS-CoV-2 Omicron to antibody neutralization, Nature
Taji, Thomas, Oliver, COVID-19 in patients undergoing long-term dialysis in Ontario, CMAJ
Toussi, Neutel, Navarro, Pharmacokinetics of Oral Nirmatrelvir/Ritonavir, a Protease Inhibitor for Treatment of COVID-19, in Subjects With Renal Impairment, Clin Pharmacol Ther
Wan, Chui, Lai, Bell's palsy following vaccination with mRNA (BNT162b2) and inactivated (CoronaVac) SARS-CoV-2 vaccines: a case series and nested case-control study, Lancet Infect Dis
Wan, Chui, Wang, Herpes zoster related hospitalization after inactivated (CoronaVac) and mRNA (BNT162b2) SARS-CoV-2 vaccination: A self-controlled case series and nested case-control study, Lancet Reg Health West Pac
Williamson, Walker, Bhaskaran, Factors associated with COVID-19-related death using OpenSAFELY, Nature
Wong, Lau, Xiong, Adverse events of special interest and mortality following vaccination with mRNA (BNT162b2) and inactivated (CoronaVac) SARS-CoV-2 vaccines in Hong Kong: A retrospective study, PLoS Med
Zhou, Yu, Du, Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, The lancet
{ 'indexed': {'date-parts': [[2024, 2, 11]], 'date-time': '2024-02-11T12:16:36Z', 'timestamp': 1707653796441},
'reference-count': 36,
'publisher': 'Elsevier BV',
'license': [ { 'start': { 'date-parts': [[2024, 2, 1]],
'date-time': '2024-02-01T00:00:00Z',
'timestamp': 1706745600000},
'content-version': 'tdm',
'delay-in-days': 0,
'URL': 'https://www.elsevier.com/tdm/userlicense/1.0/'},
{ 'start': { 'date-parts': [[2024, 2, 6]],
'date-time': '2024-02-06T00:00:00Z',
'timestamp': 1707177600000},
'content-version': 'vor',
'delay-in-days': 5,
'URL': 'http://creativecommons.org/licenses/by-nc-nd/4.0/'}],
'content-domain': { 'domain': ['kireports.org', 'elsevier.com', 'sciencedirect.com'],
'crossmark-restriction': True},
'published-print': {'date-parts': [[2024, 2]]},
'DOI': '10.1016/j.ekir.2024.02.009',
'type': 'journal-article',
'created': {'date-parts': [[2024, 2, 9]], 'date-time': '2024-02-09T17:40:16Z', 'timestamp': 1707500416000},
'update-policy': 'http://dx.doi.org/10.1016/elsevier_cm_policy',
'source': 'Crossref',
'is-referenced-by-count': 0,
'title': 'Effectiveness of molnupiravir and nirmatrelvir–ritonavir in CKD patients with COVID-19.',
'prefix': '10.1016',
'author': [ {'given': 'Franco Wing Tak', 'family': 'Cheng', 'sequence': 'first', 'affiliation': []},
{'given': 'Vincent Ka Chun', 'family': 'Yan', 'sequence': 'additional', 'affiliation': []},
{'given': 'Eric Yuk Fai', 'family': 'Wan', 'sequence': 'additional', 'affiliation': []},
{'given': 'Celine Sze Ling', 'family': 'Chui', 'sequence': 'additional', 'affiliation': []},
{'given': 'Francisco Tsz Tsun', 'family': 'Lai', 'sequence': 'additional', 'affiliation': []},
{'given': 'Carlos King Ho', 'family': 'Wong', 'sequence': 'additional', 'affiliation': []},
{'given': 'Xue', 'family': 'Li', 'sequence': 'additional', 'affiliation': []},
{'given': 'Irene Ran', 'family': 'Zhang', 'sequence': 'additional', 'affiliation': []},
{'given': 'Sydney Chi Wai', 'family': 'Tang', 'sequence': 'additional', 'affiliation': []},
{'given': 'Ian Chi Kei', 'family': 'Wong', 'sequence': 'additional', 'affiliation': []},
{'given': 'Esther Wai Yin', 'family': 'Chan', 'sequence': 'additional', 'affiliation': []}],
'member': '78',
'reference': [ { 'key': '10.1016/j.ekir.2024.02.009_bib1',
'doi-asserted-by': 'crossref',
'first-page': '430',
'DOI': '10.1038/s41586-020-2521-4',
'article-title': 'Factors associated with COVID-19-related death using OpenSAFELY',
'volume': '584',
'author': 'Williamson',
'year': '2020',
'journal-title': 'Nature'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib2',
'doi-asserted-by': 'crossref',
'DOI': '10.7189/jogh.10.020503',
'article-title': 'Effects of underlying morbidities on the occurrence of deaths in '
'COVID-19 patients: A systematic review and meta-analysis',
'volume': '10',
'author': 'Khan',
'year': '2020',
'journal-title': 'J Glob Health'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib3',
'doi-asserted-by': 'crossref',
'first-page': '190',
'DOI': '10.1053/j.ajkd.2020.09.003',
'article-title': 'Characteristics and Outcomes of Individuals With Pre-existing Kidney '
'Disease and COVID-19 Admitted to Intensive Care Units in the United '
'States',
'volume': '77',
'author': 'Flythe',
'year': '2021',
'journal-title': 'Am J Kidney Dis'},
{ 'issue': '22',
'key': '10.1016/j.ekir.2024.02.009_bib4',
'article-title': 'The effectiveness and safety of mRNA (BNT162b2) and inactivated '
'(CoronaVac) COVID-19 vaccines among individuals with chronic kidney '
'diseases',
'volume': 'S0085-2538',
'author': 'Cheng',
'year': '2022',
'journal-title': 'Kidney Int'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib5',
'doi-asserted-by': 'crossref',
'first-page': 'E278',
'DOI': '10.1503/cmaj.202601',
'article-title': 'COVID-19 in patients undergoing long-term dialysis in Ontario',
'volume': '193',
'author': 'Taji',
'year': '2021',
'journal-title': 'CMAJ'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib6',
'doi-asserted-by': 'crossref',
'first-page': '2292',
'DOI': '10.1016/j.ekir.2021.06.027',
'article-title': 'Review of Early Immune Response to SARS-CoV-2 Vaccination Among '
'Patients With CKD',
'volume': '6',
'author': 'Carr',
'year': '2021',
'journal-title': 'Kidney Int Rep'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib7',
'doi-asserted-by': 'crossref',
'first-page': '671',
'DOI': '10.1038/s41586-021-04389-z',
'article-title': 'Considerable escape of SARS-CoV-2 Omicron to antibody neutralization',
'volume': '602',
'author': 'Planas',
'year': '2022',
'journal-title': 'Nature'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib8',
'unstructured': 'Update: FDA Authorizes Additional Oral Antiviral Treatment of COVID-19 '
'in Certain Adults. 2021;'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib9',
'unstructured': 'Update: FDA authorizes first oral antiviral for treatment of COVID-19. '
'2021;'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib10',
'doi-asserted-by': 'crossref',
'first-page': '509',
'DOI': '10.1056/NEJMoa2116044',
'article-title': 'Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients',
'volume': '386',
'author': 'Jayk Bernal',
'year': '2022',
'journal-title': 'N Engl J Med'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib11',
'doi-asserted-by': 'crossref',
'first-page': '1397',
'DOI': '10.1056/NEJMoa2118542',
'article-title': 'Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19',
'volume': '386',
'author': 'Hammond',
'year': '2022',
'journal-title': 'N Engl J Med'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib12',
'doi-asserted-by': 'crossref',
'DOI': '10.3389/fphar.2023.1053814',
'article-title': 'How to use COVID-19 antiviral drugs in patients with chronic kidney '
'disease',
'volume': '14',
'author': 'Kale',
'year': '2023',
'journal-title': 'Front Pharmacol'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib13',
'doi-asserted-by': 'crossref',
'first-page': '892',
'DOI': '10.1002/cpt.2688',
'article-title': 'Pharmacokinetics of Oral Nirmatrelvir/Ritonavir, a Protease Inhibitor '
'for Treatment of COVID-19, in Subjects With Renal Impairment',
'volume': '112',
'author': 'Toussi',
'year': '2022',
'journal-title': 'Clin Pharmacol Ther'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib14',
'unstructured': 'Free COVID-19 oral drugs plan set. 2022;'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib15',
'unstructured': 'LCQ7: Introduction of new drugs for treating Coronavirus Disease 2019. '
'2022;'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib16',
'unstructured': 'First shipment of COVID-19 oral drug Paxlovid distributed to HA for '
'application (with photos). 2022;'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib17',
'article-title': 'Risk of glomerular diseases, proteinuria and hematuria following mRNA '
'(BNT162b2) and inactivated (CoronaVac) SARS-CoV-2 vaccines',
'author': 'Cheng',
'year': '2022',
'journal-title': 'Nephrol Dial Transplant'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib18',
'article-title': 'Epidemiology of Acute Myocarditis/Pericarditis in Hong Kong Adolescents '
'Following Comirnaty Vaccination',
'author': 'Chua',
'year': '2021',
'journal-title': 'Clin Infect Dis'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib19',
'doi-asserted-by': 'crossref',
'article-title': 'Thromboembolic events and hemorrhagic stroke after mRNA (BNT162b2) and '
'inactivated (CoronaVac) covid-19 vaccination: a self-controlled case '
'series study',
'author': 'Chui',
'year': '2022',
'journal-title': 'eClinicalMedicine',
'DOI': '10.1016/j.eclinm.2022.101504'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib20',
'doi-asserted-by': 'crossref',
'article-title': 'Carditis After COVID-19 Vaccination With a Messenger RNA Vaccine and an '
'Inactivated Virus Vaccine : A Case-Control Study',
'author': 'Lai',
'year': '2022',
'journal-title': 'Ann Intern Med',
'DOI': '10.7326/M21-3700'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib21',
'doi-asserted-by': 'crossref',
'first-page': '64',
'DOI': '10.1016/S1473-3099(21)00451-5',
'article-title': 'Bell’s palsy following vaccination with mRNA (BNT162b2) and inactivated '
'(CoronaVac) SARS-CoV-2 vaccines: a case series and nested case-control '
'study',
'volume': '22',
'author': 'Wan',
'year': '2022',
'journal-title': 'Lancet Infect Dis'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib22',
'article-title': 'Herpes zoster related hospitalization after inactivated (CoronaVac) and '
'mRNA (BNT162b2) SARS-CoV-2 vaccination: A self-controlled case series '
'and nested case-control study',
'volume': '21',
'author': 'Wan',
'year': '2022',
'journal-title': 'Lancet Reg Health West Pac'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib23',
'doi-asserted-by': 'crossref',
'DOI': '10.1371/journal.pmed.1004018',
'article-title': 'Adverse events of special interest and mortality following vaccination '
'with mRNA (BNT162b2) and inactivated (CoronaVac) SARS-CoV-2 vaccines in '
'Hong Kong: A retrospective study',
'volume': '19',
'author': 'Wong',
'year': '2022',
'journal-title': 'PLoS Med'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib24',
'doi-asserted-by': 'crossref',
'first-page': '1345',
'DOI': '10.1056/NEJMp2113319',
'article-title': 'Methods of Public Health Research — Strengthening Causal Inference from '
'Observational Data',
'volume': '385',
'author': 'Hernán',
'year': '2021',
'journal-title': 'New England Journal of Medicine'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib25',
'doi-asserted-by': 'crossref',
'first-page': '758',
'DOI': '10.1093/aje/kwv254',
'article-title': 'Using Big Data to Emulate a Target Trial When a Randomized Trial Is Not '
'Available',
'volume': '183',
'author': 'Hernán',
'year': '2016',
'journal-title': 'Am J Epidemiol'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib26',
'unstructured': 'Fact Sheet for Health Care Providers Emergency Use Authorization (EUA) '
'For Paxlovid. 2022;'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib27',
'doi-asserted-by': 'crossref',
'first-page': '1501',
'DOI': '10.1002/sim.4780091214',
'article-title': 'Relation of pooled logistic regression to time dependent Cox regression '
'analysis: the Framingham Heart Study',
'volume': '9',
'author': 'D’Agostino',
'year': '1990',
'journal-title': 'Stat Med'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib28',
'doi-asserted-by': 'crossref',
'first-page': '561',
'DOI': '10.1097/00001648-200009000-00012',
'article-title': 'Marginal structural models to estimate the causal effect of zidovudine '
'on the survival of HIV-positive men',
'volume': '11',
'author': 'Hernán',
'year': '2000',
'journal-title': 'Epidemiology'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib29',
'doi-asserted-by': 'crossref',
'DOI': '10.1056/EVIDoa2100044',
'article-title': 'Randomized Trial of Molnupiravir or Placebo in Patients Hospitalized '
'with Covid-19',
'volume': '1',
'author': 'Arribas',
'year': '2022',
'journal-title': 'NEJM Evidence'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib30',
'article-title': 'Evaluation of publication bias for 12 clinical trials of molnupiravir '
'to treat SARS-CoV-2 infection in 13,694 patients',
'author': 'Lawrence',
'year': '2022',
'journal-title': 'Research Square'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib31',
'article-title': 'Oral antiviral therapies for COVID-19 in patients with advanced chronic '
'kidney disease or kidney failure',
'author': 'Cho',
'year': '2023',
'journal-title': 'Nephrol Dial Transplant'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib32',
'doi-asserted-by': 'crossref',
'DOI': '10.1371/journal.pmed.1003321',
'article-title': 'Comorbidities associated with mortality in 31,461 adults with COVID-19 '
'in the United States: A federated electronic medical record analysis',
'volume': '17',
'author': 'Harrison',
'year': '2020',
'journal-title': 'PLoS medicine'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib33',
'doi-asserted-by': 'crossref',
'first-page': '1054',
'DOI': '10.1016/S0140-6736(20)30566-3',
'article-title': 'Clinical course and risk factors for mortality of adult inpatients with '
'COVID-19 in Wuhan, China: a retrospective cohort study',
'volume': '395',
'author': 'Zhou',
'year': '2020',
'journal-title': 'The lancet'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib34',
'doi-asserted-by': 'crossref',
'first-page': 'm1966',
'DOI': '10.1136/bmj.m1966',
'article-title': 'Factors associated with hospital admission and critical illness among '
'5279 people with coronavirus disease 2019 in New York City: prospective '
'cohort study',
'volume': '369',
'author': 'Petrilli',
'year': '2020',
'journal-title': 'BMJ'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib35',
'doi-asserted-by': 'crossref',
'first-page': 'e4025',
'DOI': '10.1093/cid/ciaa924',
'article-title': 'Association Between Male Sex and Outcomes of Coronavirus Disease 2019 '
'(COVID-19)-A Danish Nationwide, Register-based Study',
'volume': '73',
'author': 'Kragholm',
'year': '2021',
'journal-title': 'Clin Infect Dis'},
{ 'key': '10.1016/j.ekir.2024.02.009_bib36',
'doi-asserted-by': 'crossref',
'first-page': '6317',
'DOI': '10.1038/s41467-020-19741-6',
'article-title': 'Male sex identified by global COVID-19 meta-analysis as a risk factor '
'for death and ITU admission',
'volume': '11',
'author': 'Peckham',
'year': '2020',
'journal-title': 'Nat Commun'}],
'container-title': 'Kidney International Reports',
'original-title': [],
'language': 'en',
'link': [ { 'URL': 'https://api.elsevier.com/content/article/PII:S2468024924000986?httpAccept=text/xml',
'content-type': 'text/xml',
'content-version': 'vor',
'intended-application': 'text-mining'},
{ 'URL': 'https://api.elsevier.com/content/article/PII:S2468024924000986?httpAccept=text/plain',
'content-type': 'text/plain',
'content-version': 'vor',
'intended-application': 'text-mining'}],
'deposited': { 'date-parts': [[2024, 2, 9]],
'date-time': '2024-02-09T17:40:32Z',
'timestamp': 1707500432000},
'score': 1,
'resource': {'primary': {'URL': 'https://linkinghub.elsevier.com/retrieve/pii/S2468024924000986'}},
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2024, 2]]},
'references-count': 36,
'alternative-id': ['S2468024924000986'],
'URL': 'http://dx.doi.org/10.1016/j.ekir.2024.02.009',
'relation': {},
'ISSN': ['2468-0249'],
'subject': ['Nephrology'],
'container-title-short': 'Kidney International Reports',
'published': {'date-parts': [[2024, 2]]},
'assertion': [ {'value': 'Elsevier', 'name': 'publisher', 'label': 'This article is maintained by'},
{ 'value': 'Effectiveness of molnupiravir and nirmatrelvir–ritonavir in CKD patients with '
'COVID-19.',
'name': 'articletitle',
'label': 'Article Title'},
{'value': 'Kidney International Reports', 'name': 'journaltitle', 'label': 'Journal Title'},
{ 'value': 'https://doi.org/10.1016/j.ekir.2024.02.009',
'name': 'articlelink',
'label': 'CrossRef DOI link to publisher maintained version'},
{'value': 'article', 'name': 'content_type', 'label': 'Content Type'},
{ 'value': '© 2024 Published by Elsevier Inc. on behalf of the International Society of '
'Nephrology.',
'name': 'copyright',
'label': 'Copyright'}]}
