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. 2022 Aug 19;79(17):1415-1423.
doi: 10.1093/ajhp/zxac139.

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

Roger H Kobayashi  1 , Michael T Rigas  2
Affiliations

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

Roger H Kobayashi et al. Am J Health Syst Pharm. .

Abstract

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.

Keywords: chronic kidney disease; high-dose immune globulin; immune globulin; intravenous immune globulin; renal impairment; subcutaneous immune globulin.

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Figure 1.
Screening for risk factors for kidney impairment.
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