title: Reduced time for urinary alkalinization before high-dose methotrexate with preadmission oral bicarbonate.
abstract: OBJECTIVE
  Hydration and urinary alkalinization are essential for reducing renal dysfunction with high dose methotrexate (HDMTX). This report presents an analysis of institutional methods used to achieve adequate urinary alkalinization and output for patients receiving single agent HDMTX. Renal and metabolic parameters of tolerance were examined.
  
  
  METHODS
  Medical records of adult patients receiving HDMTX during the calendar years of 2008-2009 were retrospectively reviewed to determine the time to achieve urine pH > 7. Number of hospital days, bicarbonate dose, ordered hydration rate, urine output, and urine pH were assessed. A survival analysis model was run for time to urine pH > 7 using preadmission oral bicarbonate as a predictor variable and including a frailty term. Observational statistics were performed for other parameters.
  
  
  RESULTS
  The analysis included 79 encounters for ten patients. Urine pH > 7 was achieved more rapidly in patients receiving preadmission oral bicarbonate (P = 0.012). The number of patients receiving HDMTX on the same day as admission was greater for those receiving preadmission oral bicarbonate (47%) in comparison to those who did not (2%), and they spent less time in the hospital. A standard regimen for hydration and urinary alkalinization based on this project is reported. The nature and frequency of adverse events were as expected for this treatment.
  
  
  CONCLUSIONS
  At our institution, the time to achieve urinary alkalinization was reduced for patients receiving preadmission oral bicarbonate which facilitated chemotherapy infusion on the same day as admission and decreased the number of calendar days that patients stayed in the hospital.
authors.affiliation: Spectrum Health Hospitals, Grand Rapids, MI, USA. polly.kintzel@spectrumhealth.org
authors.forename: Polly E
authors.initials: PE
authors.lastname: Kintzel
authors.forename: Alan D
authors.initials: AD
authors.lastname: Campbell
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Yost
authors.forename: Brett T
authors.initials: BT
authors.lastname: Brinker
authors.forename: Nicole V
authors.initials: NV
authors.lastname: Arradaza
authors.forename: Daniel
authors.initials: D
authors.lastname: Frobish
authors.forename: Alison M
authors.initials: AM
authors.lastname: Wehr
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: O'Rourke
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000517:prevention & control / Q000652:urine*; D000284:Administration, Oral; D000368:Aged; D001639:Bicarbonates / Q000008:administration & dosage*; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000639:trends; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects / Q000652:urine*; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016482:Urinalysis / Q000379:methods
chemical_list: D001639:Bicarbonates; D008727:Methotrexate