From the Research
Nintedanib can be used cautiously in patients with Idiopathic Pulmonary Fibrosis (IPF) and Chronic Kidney Disease (CKD), but dose adjustment and close monitoring are necessary to minimize potential side effects while maintaining efficacy.
Recommendation:
- Start with a reduced dose of 100 mg twice daily
- Monitor renal function and drug side effects closely
- Adjust dose based on tolerability and renal function
Additional considerations:
- Perform baseline renal function tests before starting treatment
- Check liver function tests regularly, as nintedanib can cause hepatotoxicity 1
- Be vigilant for gastrointestinal side effects, particularly diarrhea 1
- Consider drug interactions, especially with anticoagulants The most recent and highest quality study 2 suggests that nintedanib can be safely used in patients with IPF and CKD, with careful monitoring of liver and kidney function. Although the study had a small sample size, it provides valuable insights into the safety and efficacy of nintedanib in this patient population. The study found that nintedanib improved pulmonary function and was well-tolerated, with sporadic episodes of diarrhea being the only notable side effect. Nintedanib is primarily metabolized by the liver, with minimal renal excretion 3. However, CKD can affect drug metabolism and clearance indirectly. The reduced starting dose aims to minimize potential side effects while maintaining efficacy. Close monitoring allows for dose optimization based on individual patient response and tolerability. The caution is warranted due to the complex interplay between CKD, drug metabolism, and the potential for adverse effects in an already vulnerable patient population with IPF. A meta-analysis of randomized controlled trials 4 found that nintedanib was effective in reducing the annual rate of decline in forced vital capacity (FVC) in patients with ILD, including those with and without systemic sclerosis. However, the incidence of adverse events and withdrawals due to adverse events was higher in the nintedanib group compared to the placebo group. Overall, the available evidence suggests that nintedanib can be used cautiously in patients with IPF and CKD, but close monitoring and dose adjustment are necessary to minimize potential side effects while maintaining efficacy.