Use of i.v. immune globulin and occurrence of associated acute renal failure and thrombosis

Abstract

The use trends of i.v. immune globulin (IGIV) and the frequency of acute renal failure (ARF) and thrombosis at one institution were studied. A retrospective chart review on the indications and dosages of IGIV was conducted with inpatients and outpatients at a Veterans Affairs medical center between May 1, 1998, and June 30, 2003. Patients under 18 years of age were excluded from the study. Patient data were obtained through the center's computerized patient record system and included patient demographics, comorbidities, frequency of ARF, concomitant therapies, and IGIV therapy courses. ARF was defined as an increase in serum creatinine of >/=0.5 mg/dL within 10 days from the initiation of IGIV therapy. Forty-six patients were identified as receiving at least one cycle of IGIV therapy between May 1, 1998, and June 30, 2003. The three main indications for IGIV therapy were hypogammaglobulinemia, idiopathic thrombocytopenic purpura (ITP), and chronic inflammatory demyelinating polyneuropathy (CIDP). No new cases of thrombosis were found. Six patients (13%) developed ARF after IGIV administration, but none required dialysis. A greater percentage of patients with ARF were 65 years or older, had chronic renal insufficiency or diabetes mellitus, and used nephrotoxic agents, compared with patients who did not develop ARF. No association was observed between ARF and underlying primary disease. A retrospective review of 46 courses of IGIV therapy showed that the therapy was most often used for hematologic, neurologic, and immunologic indications, and the most common diagnoses for which it was used were hypogammaglobulinemia, ITP, and CIDP. ARF developed in 13% of patients, but no case of thrombosis was reported.