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Effective removal of methotrexate by high-flux hemodialysis

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Abstract.

The purpose of the present study was to examine the clearance of methotrexate (MTX) by high-flux hemodialysis (HD) in pediatric oncology patients. We present three patients who experienced nephrotoxicity and prolonged exposure to toxic MTX concentrations following high-dose infusions during treatment for osteogenic sarcomas. Each patient was successfully treated with high-flux HD, followed by carboxypeptidase G2 (CPDG2) in two cases. Minimal systemic toxicity occurred. We review the literature and discuss guidelines for early and aggressive treatment for this complication of high-dose MTX therapy. Clinically important removal of MTX depends upon prompt initiation of HD after detection of nephrotoxicity and delayed clearance of MTX. Therapy is indicated in cases where compassionate use of CPDG2 may not be available, or while awaiting its delivery.

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Authors and Affiliations

  1. Department of Pediatrics, The Mount Sinai School of Medicine, One Gustave L. Levy Place Box 1664, NY 10029–6574, USA, , , , ,

    Jeffrey Saland

  2. Department of Pediatrics, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390–9063, USA, , , , ,

    Patrick J. Leavey, Robert O. Bash & Raymond Quigley

  3. Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Room 1436D, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8, , , , ,

    Eleonora Hansch & Gerald S. Arbus

Authors
  1. Jeffrey Saland
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  2. Patrick J. Leavey
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  3. Robert O. Bash
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  4. Eleonora Hansch
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  5. Gerald S. Arbus
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  6. Raymond Quigley
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Saland, J., Leavey, P.J., Bash, R.O. et al. Effective removal of methotrexate by high-flux hemodialysis. Pediatr Nephrol 17, 825–829 (2002). https://doi.org/10.1007/s00467-002-0946-7

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  • DOI: https://doi.org/10.1007/s00467-002-0946-7

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