2019
DOI: 10.1590/2175-8239-jbn-2018-0095
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Successful multiple-exchange peritoneal dialysis in a patient with severe hematological toxicity by methotrexate: case report and literature review

Abstract: Methotrexate is an effective medication to control several diseases; however, it can be very toxic, being myelosuppression one of its main adverse effects, which increases in severity and frequency in patients with renal failure. We present the case of a 68-year-old man with chronic, end-stage renal disease associated with ANCA vasculitis, under treatment with peritoneal dialysis, who received the medication at a low dose, indicated by disease activity, which presented as a complication with severe pancytopeni… Show more

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Cited by 11 publications
(11 citation statements)
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“…In an 89-year-old woman with acute pyelonephritis, septic shock, atrial fibrillation, and worsening renal failure, HD had to be changed to PD due to type II heparin-induced thrombocytopenia [ 36 ]. PD was intensified to avoid installing an HD catheter in a patient with severe thrombocytopenia after methotrexate administration [ 37 ]. In gram-negative sepsis and AKI, DIC can contribute to a decrease in platelet count [ 38 ].…”
Section: Discussionmentioning
confidence: 99%
“…In an 89-year-old woman with acute pyelonephritis, septic shock, atrial fibrillation, and worsening renal failure, HD had to be changed to PD due to type II heparin-induced thrombocytopenia [ 36 ]. PD was intensified to avoid installing an HD catheter in a patient with severe thrombocytopenia after methotrexate administration [ 37 ]. In gram-negative sepsis and AKI, DIC can contribute to a decrease in platelet count [ 38 ].…”
Section: Discussionmentioning
confidence: 99%
“…Drug clearance depends on the volume and number of PD exchanges. The optimal prescription in the poisoning context is unclear, but case series generally report use of automated PD with hourly exchanges of various volumes [117,118]. The authors' preference in adult patients is 2 L intraperitoneal exchanges if tolerated.…”
Section: Peritoneal Dialysismentioning
confidence: 99%
“…About 25% of patients on long-term low-dose oral methotrexate develop some degree of toxicity that limits treatment (111-113), including myelosuppression (1%-10%) (112-120), elevated liver enzymes (10%-25%) (112,113,117, 120-123), and mucositis (5%-20%) (112,113,118). No AKI/CKD 5-15 (13,23,31-37,170,180,183,188,194,195,197,200,203,205-207, 209,210,212-216,221-224,227,230,232,235,237,245,250,268 Preexisting CKD (113,115,124,125), kidney failure (even after a single dose of 2.5 mg) (32, [126][127][128][129][130][131][132][133][134][135], or AKI during maintenance methotrexate therapy (113,(136)(137)(138) are major risk factors for developing toxicity. Other risk factors include length of exposure, weekly dosing, cumulative dose (111,115,137,139,140), and lack of folate supplementation (141).…”
Section: Overview Of Methotrexate Toxicitymentioning
confidence: 99%
“…Mortality in patients developing toxicity from oral methotrexate is 5%-30% (115)(116)(117)119,(125)(126)(127)(128)137,138,(142)(143)(144)(145). In contrast to high-dose methotrexate, therapeutic drug monitoring has little value in low-dose methotrexate toxicity (129), as no correlation exists between toxicity and methotrexate concentrations, and morbidity is reported at undetectable concentrations (68,130,137,138).…”
Section: Overview Of Methotrexate Toxicitymentioning
confidence: 99%