Immunoglobulin preparations affect hyponatremia in Kawasaki disease

Kaneko, Kazunari; Hirabayashi, Masato; Tateiwa, Ai; Shimo, Tomohiko; Teranishi, Kenji; Tanaka, Sachiyo; Yoshimura, Ken; Kino, Motoki; Okazaki, Hitoshi; Harada, Yuka

doi:10.1007/s00431-010-1155-1

Cited by 5 publications

(5 citation statements)

References 9 publications

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“…It should be noted that the sodium content of intravenous immunoglobulin (IVIG) that can be used for Kawasaki disease in Japan can range from trace to 154 mEq/L. Kaneko et al report that when children with hyponatremia caused by Kawasaki disease receive an IVIG containing little sodium, the improvement is delayed even if the hyponatremia does not worsen . Hyponatremia can cause brain edema and other factors, so patients with Kawasaki disease complicated by hyponatremia should consider using IVIG containing high concentration (154 mEq/L) of sodium.…”

mentioning

confidence: 99%

Significance of hyponatremia in Kawasaki disease

Tsuji

2020

Pediatrics International

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confidence: 99%

Significance of hyponatremia in Kawasaki disease

Tsuji

2020

Pediatrics International

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“…The present study showed that the high-Na IVIG preparation was associated with reductions in the proportions of CAAs and IVIG resistance for KD patients in the acute phase, using a large nationwide inpatient database in Japan. A previous study on patients with KD in the acute phase showed no signi cant difference in the proportion of CAAs between the high-Na IVIG group (n=48) and low-Na IVIG group (n=30) [14]. The previous study may have failed to show a signi cant difference between the two groups because of its small sample size.…”

Section: Discussionmentioning

confidence: 79%

Sodium-containing versus sodium-trace preparations of IVIG for children with Kawasaki disease in the acute phase

et al. 2021

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Objectives: Kawasaki disease (KD) is an acute systemic vasculitis that most commonly causes acquired cardiac disease in children in developed countries. The most highly recommended treatment for KD is 2 g/kg intravenous immunoglobulin (IVIG). There are two types of IVIG, sodium-containing (high Na) and sodium-trace (low Na) preparations. However, few studies have compared the effects of these two preparations for superiority. The purpose of this study was to compare outcomes between high and low Na IVIG preparations in KD children using a national inpatient database in Japan.Methods: We used the Diagnostic Procedure Combination database to identify KD patients treated with IVIG between 2010 and 2017. We identi ed those receiving high and low Na preparations of IVIG as an initial treatment. Outcomes included proportion of coronary artery abnormalities (CAA), IVIG resistance, adverse effects, length of stay, and medical cost. Propensity score-matched analyses were conducted to compare the outcomes between the two groups. Instrumental variable analyses were performed to con rm the results.Results: We identi ed 42345 patients with KD. There were signi cant differences in proportions of CAA (2.8% vs. 3.2%; p=0.031) and IVIG resistance (17% vs. 18%; p=0.001) between the two groups. However, there were no signi cant differences in length of stay or medical cost. The instrumental variable analysis con rmed the same results as the propensity score analysis.Conclusions: The present study suggests that high Na IVIG is potentially effective for reducing the proportion of CAA in KD patients. Prospective studies are warranted to con rm the effectiveness observed in this study. What Is Known:For treatments of Kawasaki Disease in acute phase, intravenous immunoglobulin have been the most recommended to reduce fever early and prevent complications of coronary artery abnormalities. There are two types of IVIG preparations, sodium-containing IVIG and sodium-trace IVIG. However, few studies have performed comparisons to determine which preparation of IVIG is superior.What Is New:The present ndings suggest that high-Na IVIG is associated with reductions in the proportions of CAAs and IVIG resistance in KD patients.

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“…After IVIG therapy, the levels of these inflammatory cytokines change depending on the response to therapy: they decline in responders and do not decline in non‐responders. Hence, serum Na level improves immediately in responders, but the hyponatremia is prolonged in non‐responders . Accordingly, serum Na may be indicative of the trends of the inflammatory cytokines during the acute stage of KD, and prolonged hyponatremia after IVIG therapy may indicate IVIG unresponsiveness.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, serum Na level improves immediately in responders, but the hyponatremia is prolonged in non-responders. 21,24,25 Accordingly, serum Na may be indicative of the trends of the inflammatory cytokines during the acute stage of KD, and prolonged hyponatremia after IVIG therapy may indicate IVIG unresponsiveness.…”

Section: Hyponatremia In Acute Kdmentioning

confidence: 99%

Indicators of unresponsiveness after initial i.v. immunoglobulin treatment in acute Kawasaki disease

Hashimoto

2019

Pediatrics International

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Background The aim of this study was to identify the indicators of unresponsiveness to initial i.v. immunoglobulin (IVIG) treatment for Kawasaki disease (KD). Methods One hundred and forty‐five patients with KD, who had received initial treatment consisting of a single IVIG dose (1 g/kg or 2 g/kg) and oral aspirin (30 mg/kg), were studied. Laboratory parameters, including C‐reactive protein (CRP) and serum sodium (Na), were measured before and after IVIG treatment, and during the convalescent phase, and the laboratory data compared with regards to IVIG response. Multiple logistic regression models, which included laboratory data obtained immediately after the IVIG treatment, were constructed to determine the indicators of IVIG unresponsiveness immediately after the completion of the initial treatment. Results On logistic regression analysis, serum Na after IVIG treatment was the only independent factor related to initial IVIG unresponsiveness (β = 0.53, P < 0.01; OR, 1.69; 95%CI: 1.15–2.49). On receiver operating characteristic curve analysis, the optimal serum Na cut‐off immediately after IVIG treatment was 135.5 mEq/L with a sensitivity of 0.75, and a specificity of 0.79. Conclusions Prolonged hyponatremia after completion of the initial IVIG therapy was an indicator of the need for subsequent IVIG therapy. Treatment plans should be established for patients with acute KD that pay particular attention to prolonged hyponatremia.

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Immunoglobulin preparations affect hyponatremia in Kawasaki disease

Cited by 5 publications

References 9 publications

Significance of hyponatremia in Kawasaki disease

Significance of hyponatremia in Kawasaki disease

Sodium-containing versus sodium-trace preparations of IVIG for children with Kawasaki disease in the acute phase

Indicators of unresponsiveness after initial i.v. immunoglobulin treatment in acute Kawasaki disease

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