Management of Prednisone in Dialysis Patients

Introduction to Prednisone Administration

The American Journal of Kidney Diseases recommends that prednisone 80mg can be given to high-risk dialysis patients with expiratory rhonchi, but prophylaxis against Pneumocystis pneumonia should be administered along with gastroprotection and bone protection according to local guidelines 1

For patients receiving high-dose glucocorticoids (prednisone equivalent ≥0.5 mg/kg/day), the American Journal of Kidney Diseases suggests that Pneumocystis jirovecii pneumonia (PJP) prophylaxis with trimethoprim-sulfamethoxazole as first-line, and atovaquone, dapsone, or pentamidine for sulfa allergies is essential 1
The American Journal of Kidney Diseases recommends gastroprotection with a proton pump inhibitor or H2 blocker to prevent peptic ulcer disease 1
Arthritis care & research suggests considering calcium and vitamin D supplementation for bone protection, and assessing for osteoporosis risk factors 2

The American Journal of Kidney Diseases states that dialysis patients are already immunocompromised and steroids further increase susceptibility to infections 1
Arthritis care & research notes that steroids increase the risk of osteoporosis in dialysis patients who often have pre-existing renal osteodystrophy 2

The American Journal of Kidney Diseases emphasizes the importance of not forgetting PJP prophylaxis with high-dose steroids (≥20mg/day for >1 month) 1