QUESTION: Basically my question is when do the risks of kidney damage outweigh the benefits of receiving IVC?? My case is as follows: 32 yo female with Osteosarcoma with lung mets. Palliative. Completed several month of chemo at which point she no longer responded to chemo and became septic requiring several weeks of IV cefazolin. Kidneys are failing progressively over the last several month based on blood work results, however clinically she remains well with no SOB, no peripheral edema, pruritus etc. She has completed a round of hyperthermia treatments. Recent CT shows some decrease and some increase in lung mets. Kidney function continue to worsen (based on labs). She was toleratING 25gIVC treatments a few weeks ago when serum creatinine was 550 and eGFR was 10. I wanted to continue these treatments here, however serum creatinine in now 775 and eGFR is 5. When I talked to Gurdev and others at the OncANP they informed me that low doses of IVC in small volumes are ok with patients who have poor kidney function and if anything they only see kidney function improve with IVC. Can I still do IV C on her with her kidneys this damaged?? She hasn’t started dialysis yet but probably will need to soon. I was comfortable doing IVC when creatinine was 500 but now it’s much higher – when do the risks of kidney damage outweigh the benefits of IVC? She really wants to try a low dose again and understands the cautions and risk with her compromised kidneys. Do you think I should try maybe 10g in a 50ml bag with a really slow drip??
ANSWER: That is a pretty low eGFR, which is what I follow. I’d do the 5-10 g IVC in 50-100 mL sterile water and re check eGFR 72 hrs post IV. If eGFR is same or better keep it up. If not, stop.