Background: Remdesivir is associated with hepatotoxicity and acute kidney injury (AKI). The objective of this study was to assess the hepatotoxicity and AKI with remdesivir. Method: This is a multicenter, retrospective cohort study for adult patients who used remdesivir for COVID-19 from 3/2020 to 10/2021. The study was conducted at Rhode Island Hospital, Rhode Island, United States. Data were analyzed with descriptive statistics as well as logistic regression analysis using STATA 18. Results: A total of 1635 patients were evaluated for hepatotoxicity: 337 developed hepatotoxicity, and 1298 had normal hepatic function. The overall median frequency of hepatotoxicity occurred in 319 patients (19.5%). Patient age (OR 1.02, 95% CI: 1–1.04, p = 0.02) and selective serotonin reuptake inhibitors (SSRIs) use (OR 1.7, 95% CI: 1.1–2.6, p = 0.01) were potential risk factors for remdesivir-associated hepatotoxicity. In contrast, being male gender was protective against remdesivir-associated hepatotoxicity (OR 0.63, 95% CI: 0.47–0.87, p = 0.02). The frequency of AKI with remdesivir occurred in 280 patients (17.3%). Conclusions: The frequency of hepatotoxicity was 19.5%, and the frequency of AKI was 17.3%. Increasing age and using SSRIs were risk factors for remdesivir-associated hepatotoxicity, while male gender was a protective factor. Clinicians should vigilantly monitor hepatic and renal functions for patients using remdesivir, especially in elderly patients.

Background/Objectives: Chronic kidney disease (CKD) is a major global health burden and is closely linked to persistent low-grade inflammation. Monocyte-based inflammatory indices, including the monocyte-to-high-density lipoprotein cholesterol ratio (MHR), monocyte-to-lymphocyte ratio (MLR), and monocyte-to-neutrophil ratio (MNR), have been associated with various metabolic and inflammatory disorders; however, their relationships with renal dysfunction and hyperuricemia remain insufficiently explored. This study examined the associations of these indices with renal dysfunction and hyperuricemia in the Saudi general population, with particular emphasis on sex-specific differences. Materials and Methods: This retrospective cross-sectional study included 9657 Saudi adults. Estimated glomerular filtration rate (eGFR) was calculated using the 2021 CKD-EPI creatinine equation. Associations of MHR, MLR, and MNR with reduced eGFR and hyperuricemia were examined using sex-stratified comparisons, correlation, risk assessment, receiver operating characteristic analysis, and regression modeling. Results: MHR was the strongest and most consistent marker associated with renal dysfunction. In females, reduced eGFR was associated with higher MHR and MLR, whereas in males it was associated with lower MHR, MLR, and MNR, indicating clear sex-specific divergence. Elevated MHR was associated with higher odds of reduced eGFR in females but lower odds in males. MHR also showed the strongest association with hyperuricemia in both sexes and remained independently inversely associated with eGFR. Conclusions: MHR showed the most consistent overall association with renal dysfunction and hyperuricemia among the evaluated indices. These findings suggest that MHR may provide a simple and accessible marker for sex-informed renal and metabolic risk assessment in the general population.