Can Erythrocyte Sedimentation Rate Predict Hypersensitivity Reactions to Rituximab Therapy in Kidney Diseases?

Introduction: This study investigates hypersensitivity reactions (HSRs) associated with rituximab therapy in nephrology patients, focusing on identifying potential risk factors. Methods Records of patients treated in our unit with rituximab for kidney diseases were reviewed between January 2019 and June 2024. Demographic, clinical, and laboratory data were evaluated to identify risk factors for HSRs. Patients were premedicated with paracetamol, diphenhydramine, and corticosteroids before rituximab infusions. Binary logistic regression analyses were performed to determine independent risk factors. Receiver operating characteristic (ROC) curve analysis were plotted to illustrate the best cut-off values of risk factors for HSRs estimation. Results 170 patients received rituximab therapy with 447 treatment doses for nephrological indications. Rituximab treatment was indicated for MN in 89/150 (57%) patients with native kidney disease. HSRs were observed in 14% of patients, including infusion-related reactions (IRRs, 10%) and rituximab-induced serum sickness (RISS, 4%). The majority of HSRs (61%) occurred during the first infusion. RISS cases were observed exclusively in patients with MN. Elevated erythrocyte sedimentation rate (ESR) was identified as an independent risk factor for HSRs (OR: 1.020, 95% CI: 1.002–1.038, p = 0.027). Besides, ESR demonstrated its predictive value for HSRs with an area under the curve (AUC) of 0.73 (95% CI: 0.637–0.826, p < 0.001), achieving a sensitivity of 74% and a specificity of 66% at a cutoff value of 38.5 mm/hour. Conclusion Elevated baseline ESR levels may serve as a predictive marker for HSRs in nephrology patients treated with rituximab. Premedication with corticosteroids may have resulted in a lower incidence of adverse events. Further prospective studies are needed to validate ESR as a biomarker for HSRs risk stratification.