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REVIEW article
Front. Med.
Sec. Nephrology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1495705
This article is part of the Research Topic When The Drug Induces Kidney Diseases: Nephrotoxicity and Intoxication/Poisoning View all 4 articles
High-Flux Hemodialysis as Rescue Therapy for High-Dose Methotrexate Toxicity: Case Series and Clinical Insights
Provisionally accepted- Hospital de Base / Faculty of Medicine of São José do Rio Preto - FAMERP, São José do Rio Preto, Brazil
High-dose methotrexate (HD-MTX) toxicity represents a significant clinical challenge in oncology, commonly resulting in acute kidney injury (AKI), myelosuppression, and potentially life-threatening multiorgan failure. This case series describes three patients treated at Hospital de Base in São José do Rio Preto, Brazil, who developed HD-MTX-induced AKI following the administration of chemotherapy. Two patients had hematologic malignancies and one had osteosarcoma. All received conventional rescue therapies, including leucovorin and aggressive hydration, but demonstrated persistent elevation of serum methotrexate levels, necessitating the initiation of high-flux hemodialysis (HF-HD). The mean number of HF-HD sessions required was 5.3 ± 2.5, and the mean relative reduction in serum methotrexate concentration was 44.5 ± 19.1%. These findings suggest that HF-HD is an effective therapeutic option for HD-MTX toxicity management in settings where glucarpidase is not readily available, although repeated sessions may be required due to the observed rebound in serum methotrexate levels.
Keywords: Methotrexate toxicity, High-dose methotrexate (HD-MTX), Acute Kidney Injury, High-flux hemodialysis, Extracorporeal treatment
Received: 13 Sep 2024; Accepted: 03 Mar 2025.
Copyright: © 2025 Tome, Santos, Lima and Ramalho. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Ana Carolina Nakamura Tome, Hospital de Base / Faculty of Medicine of São José do Rio Preto - FAMERP, São José do Rio Preto, Brazil
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