Are glomerular filtration rate estimations necessary before high dose methotrexate?

Area of Science:

• Pediatric Nephrology
• Pediatric Oncology
• Pharmacology

Background:

• High-dose methotrexate is a critical chemotherapy agent for pediatric hematological malignancies.
• Assessing kidney function, specifically glomerular filtration rate (GFR), is important due to methotrexate's nephrotoxicity.
• The clinical utility of routine GFR monitoring in this specific pediatric population is not well-established.

Purpose of the Study:

• To evaluate the impact of routine glomerular filtration rate (GFR) estimations on the clinical management of children receiving high-dose, intravenous methotrexate for hematological malignancies.

Main Methods:

• Glomerular filtration rates (GFR) were estimated in 168 children (227 estimates).
• Estimations were performed prior to the initiation of high-dose, intravenous methotrexate treatment.
• Data on clinical management decisions based on GFR results were collected.

Main Results:

• Clinical management was altered in only two cases (both with tumor lysis syndrome).
• Routine GFR estimations did not lead to significant changes in patient care for the majority of cases.
• The study assessed 168 children with 227 GFR estimates.

Conclusions:

• Routine estimation of glomerular filtration rates (GFR) does not significantly contribute to the clinical management of pediatric patients undergoing high-dose methotrexate therapy for hematological malignancies.
• The findings suggest that routine GFR monitoring may not be a cost-effective or clinically beneficial practice in this patient cohort.
• Further research could explore selective GFR monitoring in high-risk pediatric patients.