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Immune globulin therapy and kidney disease: Overview and screening, monitoring, and management recommendations

PURPOSE: This report calls attention to the potential risks of diminished kidney function when administering immune globulin (IG). The goal is to increase awareness of chronic kidney disease (CKD) and kidney function impairment in patients receiving IG and provide recommendations for screening, moni...

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Autores principales: Kobayashi, Roger H, Rigas, Michael T
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9389421/
https://www.ncbi.nlm.nih.gov/pubmed/35595720
http://dx.doi.org/10.1093/ajhp/zxac139
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author Kobayashi, Roger H
Rigas, Michael T
author_facet Kobayashi, Roger H
Rigas, Michael T
author_sort Kobayashi, Roger H
collection PubMed
description PURPOSE: This report calls attention to the potential risks of diminished kidney function when administering immune globulin (IG). The goal is to increase awareness of chronic kidney disease (CKD) and kidney function impairment in patients receiving IG and provide recommendations for screening, monitoring, and management to promote risk prevention and mitigation. SUMMARY: Human IG preparations for intravenous (IVIG) or subcutaneous (SCIG) administration are the mainstay of treatment in patients with primary immunodeficiency diseases. Increasingly, IVIG at high doses (1,000 to 2,400 mg/kg) is also used as a treatment for a variety of autoimmune and inflammatory conditions. Although some autoinflammatory disorders respond to a single course of IVIG therapy, the majority of patients require long-term, regular infusions, thereby increasing the overall risks. Often, both patients and physicians treating adults with IG are unaware of underlying CKD or kidney function impairment. This lack of awareness constitutes a major risk factor for potential worsening, particularly when using high doses of IVIG. Therefore, screening of all patients for CKD and kidney function impairment before the use of IG is essential. Identification of the cause of kidney impairment is strongly encouraged, as IG therapy may need to be modified. CONCLUSION: As detailed here, there are potential risks to patients with impaired kidney function with administration of IG, particularly at high doses. Product selection, volume, route of administration, and rate of infusion may impact those with compromised kidney function. Therefore, screening of all patients for CKD and kidney function impairment before the use of IVIG and SCIG, as well as ongoing monitoring and management, is critical. As with all potential adverse drug reactions, the best approach is to prevent them.
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spelling pubmed-93894212022-08-19 Immune globulin therapy and kidney disease: Overview and screening, monitoring, and management recommendations Kobayashi, Roger H Rigas, Michael T Am J Health Syst Pharm Clinical Review PURPOSE: This report calls attention to the potential risks of diminished kidney function when administering immune globulin (IG). The goal is to increase awareness of chronic kidney disease (CKD) and kidney function impairment in patients receiving IG and provide recommendations for screening, monitoring, and management to promote risk prevention and mitigation. SUMMARY: Human IG preparations for intravenous (IVIG) or subcutaneous (SCIG) administration are the mainstay of treatment in patients with primary immunodeficiency diseases. Increasingly, IVIG at high doses (1,000 to 2,400 mg/kg) is also used as a treatment for a variety of autoimmune and inflammatory conditions. Although some autoinflammatory disorders respond to a single course of IVIG therapy, the majority of patients require long-term, regular infusions, thereby increasing the overall risks. Often, both patients and physicians treating adults with IG are unaware of underlying CKD or kidney function impairment. This lack of awareness constitutes a major risk factor for potential worsening, particularly when using high doses of IVIG. Therefore, screening of all patients for CKD and kidney function impairment before the use of IG is essential. Identification of the cause of kidney impairment is strongly encouraged, as IG therapy may need to be modified. CONCLUSION: As detailed here, there are potential risks to patients with impaired kidney function with administration of IG, particularly at high doses. Product selection, volume, route of administration, and rate of infusion may impact those with compromised kidney function. Therefore, screening of all patients for CKD and kidney function impairment before the use of IVIG and SCIG, as well as ongoing monitoring and management, is critical. As with all potential adverse drug reactions, the best approach is to prevent them. Oxford University Press 2022-05-20 /pmc/articles/PMC9389421/ /pubmed/35595720 http://dx.doi.org/10.1093/ajhp/zxac139 Text en © American Society of Health-System Pharmacists 2022. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Review
Kobayashi, Roger H
Rigas, Michael T
Immune globulin therapy and kidney disease: Overview and screening, monitoring, and management recommendations
title Immune globulin therapy and kidney disease: Overview and screening, monitoring, and management recommendations
title_full Immune globulin therapy and kidney disease: Overview and screening, monitoring, and management recommendations
title_fullStr Immune globulin therapy and kidney disease: Overview and screening, monitoring, and management recommendations
title_full_unstemmed Immune globulin therapy and kidney disease: Overview and screening, monitoring, and management recommendations
title_short Immune globulin therapy and kidney disease: Overview and screening, monitoring, and management recommendations
title_sort immune globulin therapy and kidney disease: overview and screening, monitoring, and management recommendations
topic Clinical Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9389421/
https://www.ncbi.nlm.nih.gov/pubmed/35595720
http://dx.doi.org/10.1093/ajhp/zxac139
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