Though severe COVID-19 infection leads to acute kidney injury in 20%-40% of critically ill patients and people with end-stage kidney disease have a higher risk of both exposure and severe infection, the effects of remdesivir have not been tested on patients with renal impairment due to eGFR cutoffs. In patients with normal kidney function, 74% of remdesivir and its active metabolite are renally eliminated. There are concerns that the accumulation of both redesivir and its carrier (sulfobutylether-β-cyclodextrin) will be overly toxic in patients who cannot eliminate them as effectively (i.e. patients with kidney disease). Data from a randomized controlled trial did not show strong evidence of an increased risk of renal adverse events even though kidney injury has been shown to develop in rhesus monkeys who were given a considerably high amount of remdesivir. Oral voriconazole is generally preferred for patients with renal failure, but remdesivir (which is administered intravenously) may be necessary if the patient’s oral absorption is limited. In cases like these, the benefits of remdesivir may outweigh the risks.