Journal of Nephrology

, Volume 28, Issue 2, pp 187–191

Pemetrexed induced acute kidney injury in patients with non-small cell lung cancer: reversible and chronic renal damage


    • Nephrology and Dialysis UnitSt. Andrea Hospital
    • Nephrology Dialysis and Kidney TransplantMacchi Foundation Hospital
  • Franco Vaira
    • Oncology UnitSt. Andrea Hospital
  • Matteo Trezzi
    • Nephrology and Dialysis UnitSt. Andrea Hospital
  • Nadia Chiappini
    • Nephrology and Dialysis UnitSt. Andrea Hospital
  • Valeria Falqui
    • Nephrology and Dialysis UnitSt. Andrea Hospital
  • Francesco Londrino
    • Nephrology and Dialysis UnitSt. Andrea Hospital
Original Article

DOI: 10.1007/s40620-014-0117-5

Cite this article as:
Rombolà, G., Vaira, F., Trezzi, M. et al. J Nephrol (2015) 28: 187. doi:10.1007/s40620-014-0117-5



Pemetrexed (Alimta®) (PEM) is an antifolate antineoplastic agent effective in several tumor types, such as non-small-cell lung cancer (NSCLC) and mesothelioma, among others. It is almost exclusively excreted by the kidney and an eGFR lower 45 mL/min is a contraindication for its use: above this level PEM administration is considered safe and dose adjustment is not required. Although there are some reported cases of PEM-induced renal injury, its incidence and the negative effects on patients’ outcome has not been systematically evaluated.


We report a retrospective evaluation on the incidence of PEM-induced renal injury in patients affected by NSCLC. Between June 2010 and March 2012 a total of 38 NSCLC patients were treated at our hospital. In 29 of them other possible cause of renal injury were excluded and thus they were eligible to be analysed.


Although by protocol all of them had eGFR >45 mL/min at baseline, six patients (average eGFR 56.2 ± 11.5 mL/min/1.73 m2) developed AKI (21 %). In these six patients PEM-induced myelosuppression was more severe and hospitalization was longer. Kidney function completely recovered in four patients whereas in the other two deterioration of renal function was irreversible. The number of patients with baseline eGFR <60 mL/min/1.73 m2 was higher (4/6) in the group that developed AKI as compared to those who did not (6/23) (p < 0.05).


There is no clear cut eGFR above which PEM may be used without potential risks of renal toxicity. If PEM has to be used, all the coexisting risk factors for AKI should be possibly corrected.


Acute kidney injuryBone marrow toxicityNot small cell lung cancerPemetrexed

Copyright information

© Italian Society of Nephrology 2014