title: Pemetrexed induced acute kidney injury in patients with non-small cell lung cancer: reversible and chronic renal damage.
abstract: BACKGROUND
  Pemetrexed (Alimta(®)) (PEM) is an antifolate antineoplastic agent effective in several tumor types, such as non-small-cell lung cancer (NSCLC) and mesothelioma, among others. It is almost exclusively excreted by the kidney and an eGFR lower 45 mL/min is a contraindication for its use: above this level PEM administration is considered safe and dose adjustment is not required. Although there are some reported cases of PEM-induced renal injury, its incidence and the negative effects on patients' outcome has not been systematically evaluated.
  
  
  METHODS
  We report a retrospective evaluation on the incidence of PEM-induced renal injury in patients affected by NSCLC. Between June 2010 and March 2012 a total of 38 NSCLC patients were treated at our hospital. In 29 of them other possible cause of renal injury were excluded and thus they were eligible to be analysed.
  
  
  RESULTS
  Although by protocol all of them had eGFR >45 mL/min at baseline, six patients (average eGFR 56.2 ± 11.5 mL/min/1.73 m(2)) developed AKI (21 %). In these six patients PEM-induced myelosuppression was more severe and hospitalization was longer. Kidney function completely recovered in four patients whereas in the other two deterioration of renal function was irreversible. The number of patients with baseline eGFR <60 mL/min/1.73 m(2) was higher (4/6) in the group that developed AKI as compared to those who did not (6/23) (p < 0.05).
  
  
  CONCLUSIONS
  There is no clear cut eGFR above which PEM may be used without potential risks of renal toxicity. If PEM has to be used, all the coexisting risk factors for AKI should be possibly corrected.
authors.affiliation: Nephrology and Dialysis Unit, St. Andrea Hospital, La Spezia, Italy, giuseppe.rombola@ospedale.varese.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rombolà
authors.forename: Franco
authors.initials: F
authors.lastname: Vaira
authors.forename: Matteo
authors.initials: M
authors.lastname: Trezzi
authors.forename: Nadia
authors.initials: N
authors.lastname: Chiappini
authors.forename: Valeria
authors.initials: V
authors.lastname: Falqui
authors.forename: Francesco
authors.initials: F
authors.lastname: Londrino
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000628:therapy; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D000075202:Contraindications; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D000068437:Pemetrexed / Q000009:adverse effects*; D020127:Recovery of Function; D051436:Renal Insufficiency, Chronic / Q000139:chemically induced*; D012189:Retrospective Studies; D028761:Withholding Treatment
chemical_list: D000970:Antineoplastic Agents; D000068437:Pemetrexed