Table 2.

Immune Globulin Administration: Clinical Management Recommendations for Patients With Impaired Kidney Function

Clinical management objective	Recommendations
Minimize further kidney injury	• If kidney function estimates show a reduction in creatinine clearance of more than 15%, weight gain of greater than 2.5 pounds, or increased edema, consider the following: ◦ Reducing infusion rate—consider a maximum infusion rate of 100 mL/h ◦ Spreading out dosing to every other day (or more), as needed (ie, decreasing daily volume) ◦ Assessing hydration and oral fluid intake before and after doses ◦ Evaluating and adjusting the current regimen of diuretics ◦ Carefully monitoring and assessing comorbidities • Delve deeper into the patient’s clinical changes and develop a more comprehensive care plan
Minimize the impact of ADRs	• If ADRs occur, adjust the care plan accordingly and consider the following: ◦ Introducing the interventions described above to minimize further kidney injury ◦ Introducing/modifying an IVIG premedication regimen ◦ Changing the concentration of IVIG product or IVIG brand if the ADR is significant ◦ Changing the administration location (with additional supervision), if appropriate ◦ Switching to SCIG therapy, if the patient is agreeable to this suggestion
Manage psychological and social issues	• Address the psychological impact and social burden of living with chronic kidney disease and consider the following: ◦ Therapeutic options for depression and mental health ◦ Provision of social services or home health support services ◦ Addressing anything else the patient is concerned about, eg, access to support, insurance, supplies, progress towards goals, etc
Minimize the impact of financial issues	• If changes to insurance or the ability to afford out-of-pocket costs occur, consult with the pharmacy intake team to develop a plan to ensure the therapeutic regimen is not interrupted

Abbreviations: ADR, adverse drug reaction; SCIG, subcutaneous immune globulin; IVIG, intravenous immune globulin.