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Effects of hemoperfusion plus high-flux hemodialysis in a patient with methotrexate toxicity

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Abstract

Acute methotrexate toxicity resulting from methotrexate-induced renal fáilue is a medical emergency requiring extracorporeal removal of methotrexate. The optimum method of methotrexate removal has not yet been established. We report a case of osteosarcoma with lung metastasis that was treated with high-dose methotrexate as adjuvant chemotherapy. Although no problems occurred after the first 5 courses of methotrexate, methotrexate-induced renal failure and methotrexate toxicity appeared after the sixth course. The patient was treated, either with hemoperfusion plus high-flux hemodialysis, or hemoperfusion alone, and pre- and post-treatment serum methotrexate concentrations were monitored. The reduction in methotrexate by hemoperfusion alone for 2 hours was 54%, compared to a mean reduction of 59% by hemoperfusion combined with high-flux hemodialysis, for 3 hours. Rebound increases in methotrexate levels were small (less than 1 μmol/L) with either method. The combination of hemoperfusion and hemodialysis resulted in good control of volume status, as well as improvement in serum chemistry values.

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Authors and Affiliations

  1. Departments of School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, 160-0016, Tokyo, Japan

    Ukei Anazawa

  2. Department of Urology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, 160-0016, Tokyo, Japan

    Hirotaka Asakura & Marasu Murai

  3. Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, 160-0016, Tokyo, Japan

    Hiroyuki Sasamura, Hiroo Kumagai, Hajime Inamoto, Matsuhiko Hayashi & Takao Saruta

Authors
  1. Hiroyuki Sasamura
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  2. Ukei Anazawa
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  3. Hiroo Kumagai
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  4. Hajime Inamoto
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  5. Hirotaka Asakura
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  6. Matsuhiko Hayashi
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  7. Marasu Murai
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  8. Takao Saruta
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Sasamura, H., Anazawa, U., Kumagai, H. et al. Effects of hemoperfusion plus high-flux hemodialysis in a patient with methotrexate toxicity. Clin Exper Neph 2, 75–79 (1998). https://doi.org/10.1007/BF02480628

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  • DOI: https://doi.org/10.1007/BF02480628

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