Azvudine-Centered Comprehensive Therapeutic Strategy for the Treatment of COVID-19 Infection in Kidney Transplant Recipients in the Developing World: An Observational Pilot Study

Purpose Coronavirus disease 2019 (COVID-19) remains a serious challenge for kidney transplant recipients due to their immunocompromised status. Azvudine may be effective in treating COVID-19 in these patients, but its overall efficacy remains unclear. Methods Twenty kidney transplant COVID-19 patients at Peking University First Hospital received Azvudine-centered treatment from December 2022 to January 2023. Patients were diagnosed via COVID-19 nucleic acid testing. Demographics and treatment outcomes were collected. Results The median duration of Azvudine therapy was 9.6 days (7–14 days), and the median conversion time from positive to negative was 13.22 days (5–33 days). Transplanted renal function improved significantly (estimated glomerular filtration rate increased by 27.29 ml/min/1.73m ² , t = 9.755, p < 0.0001; serum creatinine decreased by 57.72 µmol/L, t = 10.45 p < 0.0001). All patients experienced internal environment imbalance during treatment. Half had co-infections, with Mycoplasma pneumonia being the most common (7/20, 35%). The average cost of Azvudine was 220.44 RMB (94.56-342.78 RMB). After a 1-year follow-up, 70% (14/20) of patients maintained normal transplanted kidney function. No Azvudine-related complications were observed, indicating the therapy's initial safety. Conclusion This single-center study suggests that Azvudine-centered therapy may be effective and safe for COVID-19 in kidney transplant recipients. Azvudine could be a cost-effective alternative for those with poor access to first-line anti-COVID-19 agents.