Sequential use of hemoperfusion and single-pass albumin dialysis can safely reverse methotrexate nephrotoxicity

Chan, Winnie Kwai Yu; Hui, Wun Fung

doi:10.1007/s00467-016-3389-2

Cited by 14 publications

(9 citation statements)

References 12 publications

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“…From a physiological perspective, MTX has a volume of distribution of 0.4-0.8 L/kg, a molecular weight of 454 Daltons and a plasma protein binding of 50%, so extracorporeal renal support therapy has a favorable profile for MTX elimination. However, its use is subject to debate since there is a high level of MTX binding to plasma proteins; therefore, hemoperfusion (21), hemodialysis with high cut-off filters (22), or continuous renal support by means of continuous veno-venous hemofiltration have been proposed (23). These therapeutic options can be considered in addition to the previously mentioned medical management and in cases of persistently high MTX concentrations and multisystem involvement.…”

Section: Discussionmentioning

confidence: 99%

Methotrexate nephrotoxicity in a patient with preserved renal function. Case report

2022

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Introduction: Methotrexate is a drug with chemotherapeutic properties frequently used for the treatment of certain types of cancer. The following is a clinical case which, to the best of the authors’ knowledge, is the first report in Colombia on nephrotoxicity caused by this drug and describes the consequences as well as the treatment provided at a quaternary care hospital. Case report: A 71-year-old patient with a diagnosis of non-Hodgkin’s lymphoma with normal renal function underwent chemotherapy (high-dose methotrexate intravenously) and developed stage 3 acute renal failure according to the KDIGO guidelines, which was most likely related to methotrexate intake. The patient received treatment with intravenous fluids and sodium bicarbonate as promoters of urine excretion of the toxin, and oral calcium folinate following the institutional protocol. The patient was discharged with recovery of kidney function and improved creatinine and urea nitrogen levels. Conclusion: The treatment given to the patient in this case report shows that although methotrexate nephrotoxicity is a potentially serious entity, it can have a good prognosis if treated promptly.

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Section: Discussionmentioning

confidence: 99%

Methotrexate nephrotoxicity in a patient with preserved renal function. Case report

2022

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“…Despite fast efficacy and improved tolerance with less hypersensitivity reactions and charcoal embolization nowadays, since cellulose coated charcoal filters were introduced, and in parallel with the advance of hemodialysis techniques and availability of high efficacy filters, CHP has lost popularity ( 11 ). Decline in the use of CHP relies on the high cost of the columns, which become saturated and loose effectiveness during the treatment, and short expiration time.…”

Section: Discussionmentioning

confidence: 99%

“…Hemodialysis is a suitable method for low molecular weight, water soluble molecules. Larger size molecules, such as MTX, are insufficiently removed by standard HD and require high flux filters ( 11 ). High-flux hemodialysis is the most frequently implemented extracorporeal therapy in cases of MTX toxicity but efficacy is limited ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

Charcoal Hemoperfusion for Methotrexate Toxicity: A Safe and Effective Life-Rescue Alternative When Glucarpidase Is Not Available

et al. 2021

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Background: High dose methotrexate (HDMTX) is used for the treatment of pediatric hemato-oncological diseases. HDMTX can induce acute kidney injury in cases of delayed elimination. The use of leucovorin remains the most effective rescue action. Further treatment options are of difficult access in the rare cases where leucovorin fails to prevent renal failure from occurring. Glucarpidase is an effective treatment in cases of methotrexate (MTX) delayed elimination, but cost is high and availability is limited. Charcoal hemoperfusion (CHP) is a very efficient procedure to remove protein-bound drugs, promoting fast MTX elimination, but is rarely considered as a treatment option.Methods: We present three pediatric cases with prolonged exposure to MTX after HDMTX and delayed elimination in which hemoperfusion was performed as rescue treatment for methotrexate intoxication.Results: Charcoal hemoperfusion was performed with positive results and no complications as bridging until glucarpidase was available in two cases and in one case where two doses of glucarpidase led to insufficient reduction of MTX levels.Conclusions: CHP can be considered as a rescue treatment option in MTX intoxication, since it is an effective and safe extracorporeal method for removing MTX, in cases where rescue with leucovorin is insufficient and glucarpidase is not available or while waiting for delivery.

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“…Several studies have suggested and utilized KRT as a supportive treatment and shown improvement in multiple organ systems due to clearance of chemotherapeutic agents and constant control of fluid hemodynamics (Table 6). 65–69 In a retrospective analysis of cancer patients with varying etiologies of AKI, including nephrotoxic drugs, sepsis, and tumor lysis syndrome, CVVHDF was the most widely used KRT method (followed by CVVHD and CVVHF) with an overall hospital mortality rate of 63% 64 . Only 38 patients survived, but 20 of them had a complete resolution of AKI.…”

Section: Chemotherapy‐induced Nephrotoxicity and The Role Of Kidney Replacement Therapymentioning

confidence: 99%

Changing the terminology from kidney replacement therapy to kidney support therapy

2020

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Kidney replacement therapy (KRT) is a common supportive treatment for renal dysfunction, especially acute kidney injury. However, critically ill or immunosuppressed patients with renal dysfunction often have dysfunction in other organs as well. To improve patient outcomes, clinicians began to initiate kidney replacement therapy in situations where nonrenal conditions may lead to acute kidney injury, such as septic shock, hematopoietic stem cell transplantation, veno‐occlusive renal disease, cardiopulmonary bypass, chemotherapy, tumor lysis syndrome, hyperammonemia, and various others. In this review, we discuss the use of various modes of kidney replacement therapy in treating renal and nonrenal complications to illustrate why kidney support therapy is a more appropriate terminology than kidney replacement therapy.

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Sequential use of hemoperfusion and single-pass albumin dialysis can safely reverse methotrexate nephrotoxicity

Abstract: CHP and SPAD are effective extracorporeal methods of removing methotrexate. They provide alternative treatment options for critical care nephrologists in the management of methotrexate toxicity.

Cited by 14 publications

References 12 publications

Methotrexate nephrotoxicity in a patient with preserved renal function. Case report

Methotrexate nephrotoxicity in a patient with preserved renal function. Case report

Charcoal Hemoperfusion for Methotrexate Toxicity: A Safe and Effective Life-Rescue Alternative When Glucarpidase Is Not Available

Changing the terminology from kidney replacement therapy to kidney support therapy

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