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Risk factors for high-dose methotrexate-induced nephrotoxicity
Shinichiro Kawaguchi1, Shin-Ichiro Fujiwara1,2, Rui Murahashi1
1Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
International Journal of Hematology
|March 20, 2021
Summary
Low urine pH on day 1 is a significant risk factor for high-dose methotrexate (MTX) induced nephrotoxicity. This finding aids in preventing kidney damage during cancer treatment.
Area of Science:
- Oncology
- Nephrology
- Pharmacology
Background:
- High-dose methotrexate (MTX) is crucial for hematological malignancies.
- MTX-induced nephrotoxicity remains a challenge despite supportive care.
- Identifying risk factors for MTX nephrotoxicity is essential.
Purpose of the Study:
- To evaluate risk factors for MTX-induced nephrotoxicity.
- To identify predictors of MTX nephrotoxicity in patients receiving high-dose MTX and cytosine arabinoside.
Main Methods:
- Retrospective review of 88 patients treated between 2006 and 2018.
- Analysis of patient data including MTX concentration, serum uric acid, and urine pH.
- Multivariate analysis to determine independent risk factors.
Main Results:
- Nephrotoxicity (≥ grade 2) occurred in 11 patients, exclusively those with high MTX concentrations.
- Urine pH < 7.0 at day 1 was significantly associated with nephrotoxicity (OR 8.05).
- Low urine pH predicted delayed MTX elimination and was associated with low pre-treatment serum calcium.
Conclusions:
- Low urine pH on day 1 is an independent risk factor for MTX-induced nephrotoxicity.
- Monitoring urine pH may help prevent MTX-related kidney injury.
- Pre-treatment serum calcium levels may predict the risk of developing low urine pH.
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