Methotrexate renal clearance by low-dose dopamine in severe nephrotoxicity

Grosjean, Fabrizio; Sepe, Vincenzo; Gotti, Manuel; Rossi, Marianna; Canton, Antonio Dal

doi:10.3109/0886022x.2015.1128841

Cited by 2 publications

(2 citation statements)

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“…The Supplementary material includes our literature review methodology and attrition chart. Of the 28 studies included in the literature review, 6 were observational,1–6 5 were literature reviews,7–11 and 17 were clinical case studies 12–28. Across all included studies, researchers assessed the impact of glucarpidase administration on patients with delayed Mtx clearance and/or Mtx-induced toxicity.…”

Section: Introductionmentioning

confidence: 99%

“…The majority of the studies identified in the literature review were clinical case studies, which examined patient mortality. Among patients included in the clinical case studies, nearly all (24 of 26) who received glucarpidase rescue survived the toxicity 12–28. Mortality was also a common outcome in the observational studies; however, there was variation across studies in terms of the period over which mortality was measured and whether overall mortality or mortality related to high-dose Mtx (HDMtx) was reported.…”

Section: Introductionmentioning

confidence: 99%

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<p>Length of stay, mortality, and readmissions among Medicare cancer patients treated with glucarpidase and conventional care: a retrospective study</p>

Demiralp¹,

Koenig²,

Kala³

et al. 2019

CEOR

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PurposeGlucarpidase (Voraxaze) is used to treat methotrexate (Mtx) toxicity in patients with delayed Mtx clearance due to impaired renal function. We examine hospital length of stay (LOS), mortality, and readmission rates for Medicare cancer patients with delayed clearance of Mtx treated with glucarpidase.MethodsUsing 2010–2017 Medicare claims data, we identified glucarpidase patients as those hospitalized with indications of select lymphomas or leukemia, inpatient chemotherapy, and glucarpidase treatment. We assessed outcomes of glucarpidase patients relative to those experienced by patients treated for presumed Mtx toxicity using other therapies. These nonglucarpidase patients were identified with a diagnosis of primary central nervous system lymphoma, indications of cancer-chemotherapy toxicity, and acute kidney injury during hospitalization (not present on admission), and were divided into two groups: treated with dialysis (dialysis+) and treated with or without dialysis (dialysis+/−). Inverse-probability treatment weighting using propensity scores was used to adjust for differences between groups.ResultsPatients treated with glucarpidase (n=30) had an average LOS of 14.7 days. They had inpatient, 30-day, and 90-day mortality rates of 3.3%, 13.3%, and 16.7%, respectively, and a 90-day all-cause unplanned readmission rate of 24.1%. The dialysis+ and dialysis+/− groups, respectively, had higher average LOS (40.2, 21.9), higher inpatient mortality (50.6%, 20.8%), and higher 90-day mortality (58.6%, 37.6%). No statistically significant differences in 30-day mortality or 90-day readmission rates were detected between the glucarpidase group and either of the nonglucarpidase groups. Unobservable differences in patient severity may impact the interpretation of our findings.ConclusionMedicare cancer patients with presumed Mtx toxicity receiving conventional treatment experience long hospitalizations, high intensive-care unit use and high mortality. Glucarpidase patients had lower LOS, inpatient mortality, and 90-day mortality than the non-glucarpidase patients.

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