Acute Kidney Injury Following High-Dose Methotrexate Administration in a Day Care Hospital

Area of Science:

• Oncology
• Nephrology
• Pharmacology

Background:

• Day care hospitals (DCHs) are increasingly used for cancer patient care, offering a cost-effective alternative to inpatient services.
• The shift to DCHs for chemotherapy administration necessitates careful consideration of potential risks, such as limited observation time.
• Renal toxicity is a significant concern with certain chemotherapy protocols, particularly high-dose methotrexate.

Purpose of the Study:

• To report a case of acute kidney injury (AKI) following high-dose methotrexate in a DCH setting.
• To review the literature on acid-base balance in the context of chemotherapy-induced nephrotoxicity.
• To provide recommendations for preventing renal toxicity in DCHs.

Main Methods:

• Case report presentation.
• Literature review focusing on acid-base balance, hydration, and urine alkalinization strategies.
• Analysis of risk factors for renal toxicity in day care settings.

Main Results:

• A patient developed acute kidney injury after receiving high-dose methotrexate in a DCH.
• The case underscores the potential for severe adverse events in outpatient settings.
• Literature review highlights the importance of proactive management of hydration and urine pH.

Conclusions:

• High-dose methotrexate administration in DCHs requires vigilant monitoring and specific preventive measures.
• Judicious hydration and urine alkalinization are critical for mitigating renal toxicity risk.
• Appropriate patient selection is paramount for safe chemotherapy delivery in day care settings.