Related Experiment Video

Updated: May 30, 2026

Preliminary Study on Acupuncture Combined with Grain-sized Moxibustion for Treating Rheumatoid Arthritis with Finger Joint Pain
04:50

Preliminary Study on Acupuncture Combined with Grain-sized Moxibustion for Treating Rheumatoid Arthritis with Finger Joint Pain

Published on: May 16, 2025

Methotrexate for rheumatoid arthritis patients who are on hemodialysis

Hasanein Al-Hasani1, Euthalia Roussou

  • 1Barts and The London School of Medicine and Dentistry, Turner Street, London, E1 2AD, UK.

Rheumatology International
|August 12, 2011
PubMed

Insights

Methotrexate (MTX) poses significant toxicity risks, particularly bone marrow suppression leading to pancytopenia, in end-stage renal disease (ESRD) patients undergoing hemodialysis. Standard elimination methods are ineffective, suggesting alternative therapies like anti-TNF alpha blockers may be necessary.

Area of Science:

  • Nephrology
  • Pharmacology
  • Hematology

Background:

  • Methotrexate (MTX) is frequently used in autoimmune conditions but poses toxicity risks.
  • End-stage renal disease (ESRD) patients on hemodialysis exhibit impaired drug clearance.
  • MTX toxicity, especially bone marrow suppression (pancytopenia), is a serious concern in ESRD.

Purpose of the Study:

  • To highlight the increased toxicity of Methotrexate in ESRD patients on hemodialysis.
  • To discuss the ineffectiveness of standard elimination methods for MTX in this population.
  • To explore alternative treatment options for managing conditions requiring MTX in ESRD patients.

Main Methods:

  • Review of existing literature on MTX pharmacokinetics and toxicity in renal impairment.
  • Analysis of case studies reporting MTX-induced pancytopenia in ESRD patients.
  • Evaluation of the efficacy of hemodialysis in MTX elimination.

Main Results:

  • MTX exhibits significant toxicity in ESRD patients, even at low doses.
  • Bone marrow suppression, manifesting as pancytopenia, is a prominent adverse effect.
  • Hemodialysis and other elimination methods are largely ineffective in clearing MTX from these patients.

Conclusions:

  • MTX use in ESRD patients on hemodialysis is associated with high toxicity risk.
  • Conventional MTX elimination strategies are insufficient for ESRD patients.
  • Anti-TNF alpha blockers represent a potential alternative treatment approach for ESRD patients requiring immunosuppression.

Related Concept Videos

Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents01:29

Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents

Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel Disease...
Therapeutic Drug Monitoring: Affecting Factors01:29

Therapeutic Drug Monitoring: Affecting Factors

Therapeutic Drug Monitoring (TDM) is the clinical practice of measuring specific drug levels in a patient's blood or body tissues to manage and optimize therapy. TDM is crucial for drugs with narrow therapeutic windows, like warfarin and phenytoin, where incorrect doses can lead to treatment failure or severe side effects. This monitoring ensures the dosage administered is within a safe and effective range. The factors affecting therapeutic drug monitoring include:Patient-Specific Factors:a.
Rheumatic Heart Disease III: Medical Management01:21

Rheumatic Heart Disease III: Medical Management

Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
Extracorporeal Removal of Drugs: Peritoneal Dialysis and Hemodialysis01:30

Extracorporeal Removal of Drugs: Peritoneal Dialysis and Hemodialysis

Patients with end-stage renal disease (ESRD) or those experiencing drug overdose often require extracorporeal methods to eliminate accumulated drugs and metabolites. Hemoperfusion, hemofiltration, and dialysis are the primary techniques to rapidly remove harmful substances without disrupting the patient's fluid and electrolyte balance. For those with compromised renal function, dosage adjustments of concurrent medications may be necessary during extracorporeal drug removal.Dialysis is a process...
Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy01:26

Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy

Continuous Renal Replacement Therapy (CRRT) is an essential intervention for patients experiencing severe kidney dysfunction. This therapy offers a continuous mechanism for removing fluids and toxins from the bloodstream, leveraging the patient’s blood pressure to facilitate filtration through a specialized filter. This method contrasts with intermittent dialysis, providing a gentler and more consistent removal of waste products and excess fluid, which is particularly beneficial in critically...