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Effective elimination of high-dose methotrexate by repeated hemodiafiltration and high-flux hemodialysis in patients with acute kidney injury.
Sakran, Razan; Milo, Gai; Jabareen, Ali; Artul, Tareq; Haim, Nissim; Litvak, Michael; Ringelstein-Harlev, Shimrit; Horowitz, Nethanel; Efrati, Edna; Assady, Suheir; Kurnik, Daniel.
Afiliación
  • Sakran R; Section of Clinical Pharmacology and Toxicology, 58878Rambam Health Care Campus, Haifa, Israel.
  • Milo G; Department of Nephrology, 58878Rambam Health Care Campus, Haifa, Israel.
  • Jabareen A; Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
  • Artul T; Section of Clinical Pharmacology and Toxicology, 58878Rambam Health Care Campus, Haifa, Israel.
  • Haim N; Section of Clinical Pharmacology and Toxicology, 58878Rambam Health Care Campus, Haifa, Israel.
  • Litvak M; Department of Oncology, 58878Rambam Health Care Campus, Haifa, Israel.
  • Ringelstein-Harlev S; Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
  • Horowitz N; Department of Oncology, 58878Rambam Health Care Campus, Haifa, Israel.
  • Efrati E; Department of Hematology and Bone Marrow Transplantation, 58878Rambam Health Care Campus, Haifa, Israel.
  • Assady S; Department of Hematology and Bone Marrow Transplantation, 58878Rambam Health Care Campus, Haifa, Israel.
  • Kurnik D; Section of Clinical Pharmacology and Toxicology, 58878Rambam Health Care Campus, Haifa, Israel.
J Oncol Pharm Pract ; 28(2): 508-515, 2022 Mar.
Article en En | MEDLINE | ID: mdl-34668443
INTRODUCTION: Acute kidney injury (AKI) after high dose methotrexate (HD-MTX) is associated with delayed MTX-excretion and life-threatening toxicity. Glucapridase, the recommended therapy, is expensive and not always available. CASE SERIES: We describe 3 cases (69, 67, 73 years) with diffuse large B-cell lymphoma who developed AKI and early-onset severely delayed MTX elimination after HD-MTX. MTX serum concentrations were 101 and 69 µmol/L at 24 h after administration in two patients and 34 µmol/L at 32 h in the third. MANAGEMENT AND OUTCOME: Since glucarpidase was unavailable, we performed daily high-flux hemodialysis (HF-HD) or online hemodiafiltration (HDF) sessions (median duration, 6 h). The median serum MTX elimination half-life during HDF/HF-HD sessions was similar in all patients (median, 4.4 h; IQR, 3.8-5.3 h), but serum MTX concentrations rebounded after each dialysis by a median of 40% of the trough concentrations. The three patients underwent multiple dialysis sessions, until MTX serum concentrations remained sufficiently low to be neutralized by leucovorin. Only 1 patient developed severe pancytopenia, and renal function normalized in all patients after 3-6 weeks. DISCUSSION: In conclusion, when glucarpidase is unavailable or delayed, early, repeated and prolonged HDF/HF-HD effectively enhance MTX elimination and prevent toxicity in patients with AKI and severely delayed MTX elimination after HD-MTX.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Hemodiafiltración / Lesión Renal Aguda Límite: Humans Idioma: En Revista: J Oncol Pharm Pract Asunto de la revista: FARMACIA Año: 2022 Tipo del documento: Article País de afiliación: Israel Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
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XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Hemodiafiltración / Lesión Renal Aguda Límite: Humans Idioma: En Revista: J Oncol Pharm Pract Asunto de la revista: FARMACIA Año: 2022 Tipo del documento: Article País de afiliación: Israel Pais de publicación: Reino Unido