Abstract: SA-PO193
Methotrexate-Induced AKI: A Retrospective Study
Session Information
- Onco-Nephrology: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Authors
- Gupta, Mohit, New York Presbyterian - Weill Cornell, New York, New York, United States
- Latcha, Sheron, Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Riedel, Elyn, Memorial Sloan Kettering Cancer Center, New York, New York, United States
Background
High Dose Methotrexate (HD MTX) defined as ≥ 1000 mg/m2 is used to treat several tumors including lymphomas, leukemias and osteosarcoma. In a multicenter study in patients with osteosarcoma treated with HD MTX, Widemann et al reported a rate of AKI (defined as elevation in Cr 1.5-3 X ULN)of 1.8% . We aimed to look at the rate of AKI in patients receiving HD MTX across the range of primary tumors for which it is indicated.
Methods
Data was collected on all adult patients (>18 years) who received HD MTX for all diagnoses from 01/01/2003 – 12/31/2013 at a single academic medical center. We excluded patients who had received prior or concurrent cisplatin/ ifosphamide. AKI with HD MTX was defined as 1.5 fold increase in baseline serum creatinine within 4 days after HD MTX. Clinical and demographic data were collected. Data on cumulative dose (CD) of HD MTX and number of cycles was obtained in both groups.
Results
The observed rate of AKI was 32.1% (282/880). The most common malignancies treated with HD MTX were lymphoma (75.0%) and leukemia (13.6%). Table 1 shows that advanced age (64 vs 57, p<0.0001) was associated with a higher rate of AKI. CKD III was associated with a lower rate of AKI (19.5 vs 80.5, p=0.01). The (CD) of HD MTX in patients who developed AKI was lower in comparison to those without AKI (13884 ± 10135 mg vs 22820 ± 16538 mg, p=0.0001). The number of cycles for HD-MTX was lower in patients who developed AKI (2.5 vs 4.4, p=0.0001).
Conclusion
This study is the largest single center report on the rate of AKI following HD MTX treatment across all tumor types for which the drug has an indication in adults. Lower eGFR corresponding to CKD III and shorter duration of treatment with HD MTX were associated with a lower rate of AKI. A lower (CD) of HD MTX was associated with a higher risk of AKI. These findings suggest that clinicians are reducing the dose of HD MTX in patients with CKD or following an episode of AKI. Future studies on the impact of AKI on long-term renal function in patients receiving HD MTX would assess whether such dose modification is necessary and what the effect is on long-term survivorship.