title: Methotrexate clearance by high-flux hemodialysis and peritoneal dialysis: a case report.
abstract: We report a case of a patient on maintenance peritoneal dialysis therapy treated with a high-dose methotrexate regimen for central nervous system lymphoma. For the initial methotrexate cycles, he had received temporary daily high-flux hemodialysis starting 24 hours after the infusion of methotrexate to avoid toxicity. However, on account of issues with vascular access, he was treated with continuous multiple-exchange peritoneal dialysis for the last 2 cycles of chemotherapy. Time-averaged clearances (dose divided by area under the curve, combination of endogenous and dialysis clearance) during treatment with high-flux hemodialysis and continuous multiple-exchange peritoneal dialysis were 0.77 mL/min/kg (0.013 mL/s/kg) and 0.65 mL/min/kg (0.011 mL/s/kg), respectively. Peritoneal clearance of methotrexate was estimated to be 0.124 +/- 0.037 mL/min/kg (0.00207 +/- 0.00062 mL/s/kg). Despite lower clearance by means of peritoneal dialysis compared with hemodialysis, the patient did not develop clinical evidence of methotrexate toxicity.
authors.affiliation: Department of Medicine, Renal Electrolyte and Hypertension Division, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Miho
authors.initials: M
authors.lastname: Murashima
authors.forename: Jill
authors.initials: J
authors.lastname: Adamski
authors.forename: Michael C
authors.initials: MC
authors.lastname: Milone
authors.forename: Leslie
authors.initials: L
authors.lastname: Shaw
authors.forename: Donald E
authors.initials: DE
authors.lastname: Tsai
authors.forename: Roy D
authors.initials: RD
authors.lastname: Bloom