title: Clinical dilemma over low-dose methotrexate therapy in dialysis patients: a case report and review of literature.
abstract: Myelosuppression is the life-threatening adverse effect of methotrexate. Impaired kidney function is a major aggravating factor of methotrexate-induced myelosuppression. In end-stage renal disease patients, methotrexate therapy must be with cautious because the efficacy of removal of methotrexate by means of dialysis is in doubt. In clinical practice, low-dose methotrexate is still used by clinicians in treatment of dialysis patients with immunological disorders. We reported a 61-year-old woman on continued ambulatory peritoneal dialysis who developed pancytopenia with a nadir leukocyte count of 0.03 x 109/L, leading to severe sepsis after 3 doses of methotrexate, 7.5 mg weekly. We highlighted that methotrexate therapy in dialysis patients, even with low doses could impose the risk of myelosuppression, causing a fatal outcome. Alternative medications to methotrexate might be recommended in dialysis patients.
authors.forename: Wen-Cheng
authors.initials: WC
authors.lastname: Liu
authors.forename: Hsiang-Cheng
authors.initials: HC
authors.lastname: Chen
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan. dgschen@ndmctsgh.edu.tw.
authors.forename: Jin-Shuen
authors.initials: JS
authors.lastname: Chen
mesh_terms: D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007676:Kidney Failure, Chronic / Q000628:therapy*; D007958:Leukocyte Count; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D010198:Pancytopenia / Q000097:blood / Q000139:chemically induced*; D006435:Renal Dialysis / Q000009:adverse effects*; D018805:Sepsis / Q000139:chemically induced*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D008727:Methotrexate