Kidney disease, chronic susceptibility factors

Preventing CIN is of particular importance in patients with diabetes and chronic kidney disease, as these are two of the most powerful independent risk factors for CIN (77), Diabetics are more susceptible to (CIN) than are the nondiabetics, and diabetics with pre-existing chronic kidney disease (CKD) are at even greater risk (78). In a recently proposed CIN risk-scoring system, patient characteristics such as diabetes, age >75, chronic congestive heart failure, admission with acute pulmonary edema, hypotension, anemia and chronic kidney disease and various procedure-related characteristics including increasing volumes of contrast media, and intra-aortic balloon pump use were all found to reliably contribute to increased risk (79). 

Infection risk The risk of infections and serious infections with rituximab may be similar to that with the TNT antagonists. To date, there have been no reports from trials of an increased risk of tuberculosis or opportunistic infections with rituximab [162 ]. Some investigators have reported an increase in Pneumocystis jirovecii pneumonia, and increased number of infections has been documented in patients treated with maintenance rituximab for low-grade lymphoma and in patients with concomitant severe immunodeficiency, whether caused by HIV or immunosuppressive agents [152 ]. In rheumatoid arthritis, the susceptibility factors for severe infections include chronic lung and/or cardiac disease, extra-articular involvement, and low IgG before rituximab treatment [163 ]. After kidney transplantation, the off-label use of rituximab is associated with a high risk of infectious disease and death related to infectious disease [164 ]. 

The most important susceptibility factors are pre-existing chronic kidney disease (CKD eGFR below 60 mVmin) and chronic kidney disease associated with diabetes [15]. Other factors include age over 70 years, the presence of congestive heart failure, nephrotoxic drugs (loop diuretics, metformin, nonsteroidal anti-inflammatory agents), volume depletion, and repeated exposure within short periods of time (under 72 hours). 

Susceptibility factors Renal disease In a randomized study of raloxifene in 7707 postmenopausal women with chronic kidney disease, the incidence of adverse reactions was similar to that in a control group without kidney disease [53 ]. 

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