Removal of Methotrexate by Peritoneal Dialysis and Hemodialysis in a Single Patient with End-Stage Renal Disease

@article{Diskin2006RemovalOM,
  title={Removal of Methotrexate by Peritoneal Dialysis and Hemodialysis in a Single Patient with End-Stage Renal Disease},
  author={Charles J Diskin and Thomas J. Stokes and Linda M. Dansby and Lautrec Radcliff and Thomas B. Carter},
  journal={The American Journal of the Medical Sciences},
  year={2006},
  volume={332},
  pages={156-158}
}
Background:Although methotrexate is highly bound to albumin, it is thought to be removed by hemodialysis and not by peritoneal dialysis. We are not aware of any direct comparison in the same patient. Case Report/Methods:A 60-year-old patient on continuous ambulatory peritoneal dialysis was admitted to the East Alabama Medical Center for stomatitis and pancytopenia after being given 10 mg of methotrexate for his rheumatoid arthritis. Measurements of total methotrexate levels were made before… 

Methotrexate clearance by high-flux hemodialysis and peritoneal dialysis: a case report.

Despite lower clearance by means of peritoneal dialysis compared with hemodialysis, the patient did not develop clinical evidence of methotrexate toxicity.

Successful multiple-exchange peritoneal dialysis in a patient with severe hematological toxicity by methotrexate: case report and literature review

A 68-year-old man with chronic, end-stage renal disease associated with ANCA vasculitis is presented, who received the medication at a low dose, indicated by disease activity, which presented as a complication with severe pancytopenia with mucositis that improved with support measures and multiple-exchange peritoneal dialysis.

Clinical dilemma over low-dose methotrexate therapy in dialysis patients: a case report and review of literature.

It is highlighted that methotrexate therapy in dialysis patients, even with low doses could impose the risk of myelosuppression, causing a fatal outcome.

High dose methotrexate and extended hours high-flux hemodialysis for the treatment of primary central nervous system lymphoma in a patient with end stage renal disease.

The case of a 52 year old female with post-transplant lymphoproliferative disorder, confined to the central nervous system, which was managed with high dose methotrexate (HDMTX) in the context of end stage renal disease, shows Dialysis-dependent renal failure does not preclude the use of HDMTX when required for curative therapy of malignancy.

Brief Communication High dose methotrexate and extended hours high-flux hemodialysis for the treatment of primary central nervous system lymphoma in a patient with end stage renal disease

This report discusses the case of a 52 year old female with post-transplant lymphoproliferative disorder, confined to the central nervous system, which was managed with high dose methotrexate (HDMTX)

Fatal Pancytopenia in a Hemodialysis Patient After Treatment With Low-Dose Methotrexate

It is reported that a 56-year-old male hemodialysis patient who developed fatal pancytopenia after treatment with low-dose methotrexate for psoriasis and psoriatic arthropathy should not be used to treat rheumatic conditions in dialysis patients.

Combined acute interstitial pneumonitis and pancytopenia induced by low-dose methotrexate in a hemodialysis patient treated for bullous pemphigoid*

A 48-year-old man with end-stage renal disease undergoing chronic hemodialysis developed combined acute pneumonitis and pancytopenia after a cumulative dose of 20 mg methotrexate for bullous pemphigoid after continuous renal replacement therapy (CRRT).

Pancytopenia, mucositis, and hepatotoxicity after intralesional methotrexate injection in a patient treated with peritoneal dialysis.

A 68-year-old peritoneal dialysis patient who was treated with 25 mg of intralesional methotrexate for squamous cell carcinoma of the hands developed pancytopenia, mucositis, and hepatotoxicity as a result of systemic absorption and prolonged elimination.

Severe Pancytopenia Induced by Low-dose Methotrexate in a Hemodialysis Patient

A 35-year-old woman undergoing hemodialysis developed severe stomatitis and pancytopenia after low-dose methotrexate treatment for rheumatoid arthritis, and recovered after folinic acid, granulocyte colony-stimulating factor, antibiotic and daily he modialysis therapy.

References

SHOWING 1-10 OF 13 REFERENCES

Methotrexate removal during haemodialysis in a patient with advanced laryngeal carcinoma

The rate of MTX elimination was increased during haemodialysis, although high MTX concentrations persisted for several days and prolonged rescue with folinic acid was required, although low-dose MTX was given to a patient on regular haemmodialysis without evidence of toxicity.

A high peritoneal large pore fluid flux causes hypoalbuminaemia and is a risk factor for death in peritoneal dialysis patients.

  • J. HeafS. SaracS. Afzal
  • Medicine, Biology
    Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
  • 2005
Jv(L) is related to hypoalbuminaemia and mortality after PD initiation, and it is suggested that peritoneal albumin loss can have an identical pathogenic effect as urinary albumin losses, by causing an iatrogenic "nephrotic" syndrome.

[Effectiveness of hemodialysis in a case of acute methotrexate poisoning].

A kinetic study of plasma methotrexate concentrations enabled the authors to begin treatment with high-permeability membrane haemodialysis combined with intensive folic acid loading before the clinical signs of iatrogenic toxicities developed, and to continue with haemmodialysis rather than using other depurative methods.

The safety and efficacy of the use of methotrexate in long-term therapy for rheumatoid arthritis.

Toxicity was noted at some time in 26 of 29 patients (90%), but reactions universally became mild and tolerable after adjustment of the dosage, and there was a significant reduction in mean prednisone dosage.

High‐dose methotrexate‐induced nephrotoxicity in patients with osteosarcoma

The objectives of the current study were to estimate the current incidence of HDMTX‐induced renal dysfunction in patients with osteosarcoma and to compare the efficacy and recovery of renal function for dialysis‐based methods of MTX removal with treatment using CPDG2.

Protein binding of methotrexate to human albumin and serum. A first derivative spectroscopic analysis.

The first derivative spectroscopic analysis was used to estimate the bound and free fractions of methotrexate in human serum and serum albumin (HSA), and scatchard analysis showed one family of binding sites characterized by 2 binding sites and an affinity constant close to that previously calculated using equilibrium dialysis.

Severe methotrexate intoxication in a haemodialysis patient treated for rheumatoid arthritis.

Effective clearance of methotrexate using high-flux hemodialysis membranes.

Methotrexate-induced renal failure and ineffectiveness of peritoneal dialysis.

Renal histological studies showed severe tubulointerstitial damage consistent with MTX toxicity, and better alternatives for removing MTX in patients with renal failure are clearly needed.

A high peritoneal large pore fluid flux causes hypoalbuminaemia and is a risk factor for death in PD patients

  • Nephrol Dial Transplant
  • 2005