The impact of intravenous immunoglobulin on kidney functions and thromboembolic events in dermatology patients

Abstract

Although intravenous immunoglobulin (IVIG) treatment is generally well tolerated, some adverse effects, ranging from mild to severe, can occur. Nephrotoxicity and thromboembolism are the significant adverse effects of IVIG. However, data on the frequency of thromboembolism and the impact of continuous treatment on renal functions in dermatology patients is limited. This retrospective study was conducted in a cohort of patients who received at least one high-dose (2 g/kg) IVIG cycle due to different dermatological indications, including pemphigus vulgaris, bullous pemphigoid, Stevens-Johnson syndrome, pyoderma gangrenosum, hidradenitis suppurativa and toxic epidermal necrolysis at a university hospital. Demographic and clinical information, thromboembolic events, and kidney function tests were systematically extracted from patient records. The study included 48 patients who received a total of 196 IVIG cycles with a mean dose of two cycles (range 1–41). A significant difference in renal function was observed between baseline and post-treatment in patients who received three or more IVIG cycles. In comparison, no significant difference was found in those receiving one or two IVIG cycles. Five patients (10.4%) experienced a decline of ≥ 20% in the estimated glomerular filtration rate (eGFR). In multivariate analysis, cumulative IVIG dose emerged as the sole independent predictor for a ≥ 20% decline in eGFR (OR 1.61, 95% CI 1.05–2.46, p = 0.02). Thromboembolism occurred in five patients (10.4%), with three cases arising during the first cycle. Thromboembolism, especially during the initial IVIG cycles, and decline in kidney functions related to cumulative IVIG dose were the common and significant side effects in this cohort of dermatology patients.