The Pharmacokinetics of Intradialytic Administration of Eculizumab in an Infant

Abstract

reported CNS-depressant effects. 8 Two opioids prescribed less frequently, fentanyl (6%) and methadone (4%), are among the safest opioids for patients with ESRD as they have no active metabolites and require no dose adjustments in HD. 7,8 Two patients (4%) were prescribed codeine-acetaminophen despite reported respiratory depression and narcolepsy from codeine use in kidney failure. 8 Our findings may not be generalizable to all HD patients given the small sample size from one location. Our method of determining duration of opioid therapy may over-or underestimate the true prevalence of both chronic pain and long-term opioid use in outpatient HD. Also, we did not ask patients directly about their pain, and those treated with nonopioid interventions like nonsteroidal anti-inflammatory drugs, gabapentin, transcutaneous electrical nerve stimulation units, or nerve blocks were not flagged for our review.We propose that any prescriber of opioids for HD patients reassess pain regularly and maintain a Pain Contract with the patient. Specifically, the source of pain and medication being prescribed should be documented. Reviewing available controlledsubstance databases periodically will help control for polypharmacy. We advocate selecting one provider who can best manage the HD patient's painful condition to minimize the risk for adverse events from multiple concurrent opioid prescriptions. With these measures, we aim to increase accountability and awareness when treating chronic pain in this population.

Tolerance of dinutuximab therapy for treatment of high‐risk neuroblastoma in two patients with end‐stage renal disease on dialysis

“…Similar to dinutuximab, eculizumab has an estimated molecular weight of 148 000 Da, allowing minimal renal clearance by dialysis. 17 Our two cases did develop disease progression while on antibody therapy; however, we believe this was in large part due to their active disease burden and delays in their therapy. Case 1 had no local control and very significant delay in systemic therapy given that typically dinutuxamab is started by Day +100.…”

“…We decided to proceed with 100% dinutuximab dosing based on the premise that dinutuximab does not undergo renal excretion, and as a monoclonal antibody with a high molecular weight, dinutuximab is not expected to be removed by dialysis. Similar to dinutuximab, eculizumab has an estimated molecular weight of 148 000 Da, allowing minimal renal clearance by dialysis 17 . Our two cases did develop disease progression while on antibody therapy; however, we believe this was in large part due to their active disease burden and delays in their therapy.…”