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

Diskin, Charles J.; Stokes, Thomas J.; Dansby, Linda M.; Radcliff, Lautrec; Carter, Thomas B.

doi:10.1097/00000441-200609000-00013

Cited by 22 publications

(25 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…19 Hemodialysis and peritoneal dialysis were compared by Diskin's group when tackling methotrexate toxicity in a renal failure patient who was put on peritoneal dialysis before the episode of methotrexate toxicity. 20 It was concluded that hemodialysis has a greater methotrexate removal effect than peritoneal dialysis after the first hour of dialysis. Furthermore, if peritoneal dialysis were to be used, frequent hourly exchanges of peritoneal dialysis would provide the best elimination of methotrexate thereafter.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, if peritoneal dialysis were to be used, frequent hourly exchanges of peritoneal dialysis would provide the best elimination of methotrexate thereafter. 20 Of the 13 4,7,20 The ability of methotrexate to undergo polyglutamation, which alters the spectrum of enzyme inhibition by the drug and causes retention of the polyglutamated metabolites of methotrexate within the cell, is one of the reasons that render removal by dialysis difficult. In other words, whether hemodialysis is effective in altering clinical outcome remains uncertain.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Cheung¹,

Chow²,

Szeto³

et al. 2009

JCR: Journal of Clinical Rheumatology

View full text Add to dashboard Cite

We report a 56-year-old male hemodialysis patient who developed fatal pancytopenia after treatment with low-dose methotrexate for psoriasis and psoriatic arthropathy. Risk factors identified included impaired renal function, concurrent use of nonsteroidal anti-inflammatory drugs, low serum albumin, and relatively low serum folate level. Literature review found similar risk factors in 12 other cases. Therefore, methotrexate, even as a single dose, should not be used to treat rheumatic conditions in dialysis patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Cheung¹,

Chow²,

Szeto³

et al. 2009

JCR: Journal of Clinical Rheumatology

View full text Add to dashboard Cite

show abstract

“…The difficulty of MTX removal by dialysis is owed to the fact that MTX undergoes polyglutamination, which alters the spectrum of the enzyme inhibition by the drug and causes retention of the polyglutamated metabolites of MTX within the cell, and all but one of these are less effective than MTX as an inhibitor of dihydrofolate reductase [12][13][14]. In a comparison of HD with peritoneal dialysis in the removal of MTX, it was found that HD has a greater removal affect than peritoneal dialysis within the first hour of dialysis but after this frequent hourly exchanges of peritoneal dialysis would provide the best elimination thereafter [7,12].…”

Section: Halting Methotrexate Toxicity In Hemodialysis Patients By Atmentioning

confidence: 99%

“…MTX is poorly cleared by HD, [5] but the clearance through HD is greater than through peritoneal dialysis [6,7].…”

mentioning

confidence: 99%

Methotrexate for rheumatoid arthritis patients who are on hemodialysis

Al-Hasani

Roussou

2011

Rheumatol Int

View full text Add to dashboard Cite

show abstract

“…MTX may not be effectively dialyzed; therefore, drugs competing with the organic anion transport (OAT) clearance of MTX should be carefully screened. 1 The accumulation of MTX can cause toxicities such as mucositis, bone marrow suppression, nephrotoxicity, and hepatotoxicity. Up to 90% of MTX is excreted unchanged in the urine.…”

Section: Introductionmentioning

confidence: 99%

Effect of ceftriaxone and cefepime on high-dose methotrexate clearance

Tran

Herrington

2016

J Oncol Pharm Pract

View full text Add to dashboard Cite

Numerous drug interactions with methotrexate have been identified, which can lead to serious life-threatening effects. Up to 90% of methotrexate is excreted unchanged in the urine with primary excretion dependent on organic anion transport in the renal proximal tubule. The two pathways responsible for methotrexate secretion are organic anion transport 1 and primarily organic anion transport 3. Penicillins undergo tubular secretion via organic anion transport, and cephalosporins are believed to also possess a similar risk when administered with methotrexate; however, there are no human studies observing this interaction with cephalosporins and methotrexate. Ceftriaxone undergoes biliary clearance and has low affinity for the same organic anion transports as methotrexate; therefore, ceftriaxone has a low potential to interact with methotrexate. Cefepime is primarily secreted by organic cation transport N2, and also has a low potential to interact with methotrexate. This case report describes the pharmacokinetic effect of concomitant beta-lactam therapy in a patient receiving high-dose methotrexate.

show abstract

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

Cited by 22 publications

References 7 publications

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

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

Methotrexate for rheumatoid arthritis patients who are on hemodialysis

Effect of ceftriaxone and cefepime on high-dose methotrexate clearance

Contact Info

Product

Resources

About