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Table 7 Overview of dose recommendations and other advice for therapeutic radiopharmaceuticals

From: Safe use of radiopharmaceuticals in patients with chronic kidney disease: a systematic review

Radiopharmaceutical Indication Stage of kidney failure (CKD) Dose recommendation Other advice
[131I]sodium iodine Hyperthyroidism 5 This study used a dose based on the 24-h radioiodine uptake and the weight of the gland (Demko et al. 1998) Timing of dialysis should be consistent for both 24-h uptake study and treatment, and the most reasonable time for dialysis is 24 h after administration (Demko et al. 1998)
    This study used a dose of approximately one-third of the dose based on the 24-h radioiodine uptake and the weight of the gland (Miyasaka et al. 1997) ND
    ND Standard methods of management for hyperthyroidism are effective (McKillop et al. 1985)
  Thyroid cancer 3 and 4 Guidelines should consider adjusting the dose of [131I]sodium iodine to avoid possible harmful effects of excess [131I]sodium iodine on vital organs (El-Zeftawy et al. 2017) ND
   5 Lower therapeutic doses are recommended (Aktaş et al. 2008; Pahlka and Sonnad 2006) Reconsider alternate treatment (Aktaş et al. 2008)
     The dialysis frequency and the time interval between dose administration and dialysis can both be used effectively (Pahlka and Sonnad 2006)
    Lower therapeutic doses are recommended. The patient has to be administered around 75% of normal dose (Fofi et al. 2013; Vermandel et al. 2020) Daily HD until a safe value of radioactivity for discharge was reached (Fofi et al. 2013)
     For metastatic patients pretherapeutic dosimetry studies are recommended (Vermandel et al. 2020)
    Lower therapeutic doses are recommended. The patient has to be administered around 50% of normal dose (Alevizaki et al. 2006; Bhat et al. 2017) Administer the dose as soon as possible after dialysis, while the 48-h dialysis schedule of the patient could be carried on after [131I]sodium iodine treatment (Alevizaki et al. 2006)
     The dose recommendation is based on dialysis timing and frequency of the patient (Bhat et al. 2017)
    Lower therapeutic doses are recommended. The patient has to be administered around 25% of normal dose (Daumerie et al. 1996; Holst et al. 2005; Howard and Glasser 1981; Kaptein et al. 2000; Toubert et al. 2001) First dialysis 24 h after radioiodine administration (Daumerie et al. 1996)
     Dialysis ideally should be performed just prior to the dose of [131I]sodium iodine. For radiation monitoring and precautions should be used for the first 3–4 dialysis sessions after treatment for thyroid cancer (Holst et al. 2005)
Treatment requires multidisciplinary approach involving the endocrinologist, nuclear medicine physician, nephrologist, radiation safety team, and dialysis team (Holst et al. 2005)
     Arrange dialysis 48 h after the dose (Howard and Glasser 1981)
     Based on the calculations for CAPD (Kaptein et al. 2000)
    Higher therapeutic doses are recommended (Magné et al. 2002; Morrish et al. 1990) Initiate the first dialysis after administration (Magné et al. 2002)
     Treatment procedure can be performed easily without significant radiation contamination or danger to personnel if proper precautions are observed (Magné et al. 2002)
     Delaying dialysis to 48 h (Morrish et al. 1990)
    Individual patient dosimetry/calculations are needed to make a dose recommendation (Courbon et al. 2006; Culpepper et al. 1992; Holst et al. 2005; Jiménez et al. 2001; Mello et al. 1994; Sinsakul and Ali 2004; Willegaignon et al. 2010; Yeyin et al. 2016) Proper precautions for contamination of dialysis equipment and staff exposure should be taken (Courbon et al. 2006)
     If individual dosimetry is not available, administer 25% of the normal dose (Holst et al. 2005)
     Daily HD during the first 5 days of treatment (Jiménez et al. 2001)
     Discussions with personnel from the dialysis department, radiation safety and nuclear medicine are essential in planning and execution (Mello et al. 1994)
     Careful considerations regarding the timing of dialysis must be made (Sinsakul and Ali 2004)
     Considerations about safety must be made (Sinsakul and Ali 2004)
    ND Dialysis could be done earlier to decrease the absorbed dose (Courbon et al. 1997)
     Stimulation with rhTSH simplifies the selection of 131I-doses in euthyroid dialysis patients (Driedger et al. 2006)
     Use of CAPD because of ease with which contamination with radiation could be prevented (Wang et al. 2003)
  Thyroid disease (not specified)   Factor of 3 × dose reduction (McKay and Malaroda 2019) Optimum thyroid/reminder cumulated activity ratio for dialysis starting between 36 and 48 h (McKay and Malaroda 2019)
[131I]iobenguane Pheochromocytoma 5 It may be prudent to reduce the administered dose of [131I]iobenguane given to CKD patients (Tobes et al. 1989) The alteration in biodistribution in CKD must be considered in the interpretation of [131I]iobenguane scintigraphy and in the radiation dosimetry (Tobes et al. 1989)
  1. CAPD, continuous ambulatory peritoneal dialysis; CKD, chronic kidney diseases; HD, haemodialysis; ND, ‘not determined’; rhTSH, recombinant human thyroid stimulating hormone