IVIG Removal by Dialysis
IVIG is NOT significantly removed by hemodialysis due to its high molecular weight, extensive tissue distribution, and high degree of protein binding. 1
Pharmacokinetic Properties
IVIG (intravenous immunoglobulin) consists of large IgG molecules that are not effectively cleared by standard hemodialysis due to several key characteristics:
- High molecular weight - IgG molecules are too large to pass through standard dialysis membranes 2
- Wide tissue distribution - IVIG distributes extensively throughout body tissues rather than remaining in the intravascular space 2
- High protein binding - The extensive protein binding prevents removal during dialysis 2
Clinical Implications for Dialysis Patients
No dose adjustment or supplemental dosing is required when administering IVIG to patients receiving hemodialysis. 2
Dosing Recommendations:
- Standard IVIG doses can be used in patients with end-stage renal disease (ESRD) on hemodialysis 2
- Timing of IVIG administration relative to dialysis sessions does not require modification 2
- IVIG administration to hemodialysis patients appears safe and effective 3
Important Safety Considerations:
Monitor renal function closely in dialysis patients receiving IVIG, as the product itself can cause acute renal failure. 1
- IVIG products contain varying amounts of sugars (sucrose, maltose) and sodium that can affect osmolality 3
- Different IVIG formulations have distinct adverse event profiles - Carimune at 9% concentration showed 8.2% incidence of acute renal failure 3
- Volume overload risk is particularly relevant in dialysis patients with cardiac dysfunction 2
- Assess cardiac function and fluid status before IVIG administration, especially in patients with compromised cardiac function 2
Monitoring Parameters:
- Periodic monitoring of renal function, blood urea nitrogen (BUN), and serum creatinine before and after IVIG infusion 1
- Urine output monitoring in patients at increased risk of acute renal failure 1
- Blood cell counts and serum chemistry should be monitored regularly 2
Contrast with Other Medications
Unlike IVIG, smaller molecules ARE removed by dialysis and require dose adjustments:
- Pyrazinamide and its metabolites are significantly cleared by hemodialysis (requiring post-dialysis supplementation if given before dialysis) 2
- Cycloserine is removed by hemodialysis (56% clearance) requiring dosing interval adjustments 2
- Aminoglycosides (streptomycin, kanamycin, amikacin, capreomycin) have approximately 40% removed with hemodialysis when given just before dialysis 2