Methotrexate-induced renal failure and ineffectiveness of peritoneal dialysis

Acute renal failure developed in a 47-year-old man during the second course of a high-dose methotrexate sodium (MTX) treatment for chondrosarcoma of the pelvis with pulmonary metastasis. Uninterrupted peritoneal dialysis for seven days had a negligible effect on plasma MTX. Although high-dose leucovorin calcium prevented severe myelosuppression and mucositis, the patient died 12 days after receiving MTX. Renal histological studies showed severe tubulointerstitial damage consistent with MTX toxicity. Better alternatives for removing MTX in patients with renal failure are clearly needed.