Risk factors for high-dose methotrexate-induced nephrotoxicity

High-dose methotrexate (MTX) is widely used for the treatment of hematological malignancies. Despite the application of routine supportive care measures, such as intensive fluid hydration and urine alkalinization, nephrotoxicity is still a problem. The present study aimed to evaluate the risk factor...

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Bibliographic Details
Published in:International journal of hematology 2021-07, Vol.114 (1), p.79-84
Main Authors: Kawaguchi, Shinichiro, Fujiwara, Shin-ichiro, Murahashi, Rui, Nakashima, Hirotomo, Matsuoka, Sae, Ikeda, Takashi, Toda, Yumiko, Ito, Shoko, Ban, Tetsuaki, Nagayama, Takashi, Umino, Kento, Minakata, Daisuke, Nakano, Hirofumi, Yamasaki, Ryoko, Ashizawa, Masahiro, Yamamoto, Chihiro, Hatano, Kaoru, Sato, Kazuya, Oh, Iekuni, Ohmine, Ken, Kanda, Yoshinobu
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Antimetabolites, Antineoplastic - administration & dosage
Antimetabolites, Antineoplastic - adverse effects
Antimetabolites, Antineoplastic - therapeutic use
Calcium
Calcium (blood)
Confidence intervals
Cytarabine
Cytosine
Female
Hematologic Neoplasms - drug therapy
Hematology
Humans
Kidney Diseases - blood
Kidney Diseases - chemically induced
Kidney Diseases - urine
Male
Medicine
Medicine & Public Health
Methotrexate
Methotrexate - administration & dosage
Methotrexate - adverse effects
Methotrexate - therapeutic use
Middle Aged
Multivariate analysis
Oncology
Original Article
pH effects
Retrospective Studies
Risk analysis
Risk Factors
Uric acid
Uric Acid - blood
Urine
Young Adult
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Summary:High-dose methotrexate (MTX) is widely used for the treatment of hematological malignancies. Despite the application of routine supportive care measures, such as intensive fluid hydration and urine alkalinization, nephrotoxicity is still a problem. The present study aimed to evaluate the risk factors for MTX-induced nephrotoxicity. We retrospectively reviewed 88 patients who received a regimen consisting of high-dose MTX (1000 mg/m 2 ) and cytosine arabinoside between 2006 and 2018. Nephrotoxicity (≥ grade 2) was observed in 11 patients. Nephrotoxicity was observed only in patients with a high MTX concentration. Other than the MTX concentration, the serum uric acid level and urine pH at day 1 were associated with nephrotoxicity. A multivariate analysis revealed that urine pH was an independent risk factor for MTX-induced nephrotoxicity. Urine pH 
ISSN:0925-5710
1865-3774
DOI:10.1007/s12185-021-03132-8