Hydroxychloroquine Use in Chronic Kidney Disease

Dosing and Monitoring

For patients with GFR ≥30 mL/min, the standard dosing of hydroxychloroquine at ≤5 mg/kg actual body weight can be used without adjustment, according to the American College of Rheumatology and EULAR/ERA-EDTA guidelines 1, 2, 3.
For patients with GFR <30 mL/min, the hydroxychloroquine dose should be reduced by 50% and annual ophthalmologic screening should be initiated from the start of therapy, as recommended by EULAR/ERA-EDTA guidelines 2, 3.
The American Academy of Ophthalmology guidelines emphasize that renal disease is a major risk factor for hydroxychloroquine retinopathy, requiring both dosage and screening frequency adjustments 4, 5.

Monitor serum creatinine, estimated GFR, and proteinuria regularly during hydroxychloroquine therapy, as recommended by the American College of Rheumatology and EULAR/ERA-EDTA guidelines 1, 2.
The risk of retinal toxicity increases substantially in chronic kidney disease because renal clearance of hydroxychloroquine is impaired, effectively increasing circulating drug levels, according to the American Academy of Ophthalmology guidelines 4, 5.

All patients with lupus nephritis should receive hydroxychloroquine unless contraindicated, as recommended by the American College of Rheumatology and EULAR/ERA-EDTA guidelines 1, 2, 3.
Hydroxychloroquine use is associated with higher rates of renal response, fewer renal relapses, reduced accrual of renal damage, and lower risk of end-stage kidney disease and death, according to EULAR/ERA-EDTA guidelines 2, 3.

Never use hydroxychloroquine at doses >5 mg/kg actual body weight, as this dramatically increases retinal toxicity risk, according to the American Academy of Ophthalmology guidelines 4, 5.
Patients with underlying retinal disease should generally not receive hydroxychloroquine, as it adds potentially toxic effects to already compromised retinal tissue, as recommended by the American Academy of Ophthalmology guidelines 4, 5.