Role of the establishment of protocol in the prevention of high-dose methotrexate induced acute kidney injury
10.3760/cma.j.issn.1008-5734.2017.04.007
- VernacularTitle:建立用药规范在大剂量甲氨蝶呤相关急性肾损伤防范中的作用
- Author:
Fan XIA
1
;
Jie GAO
1
;
Cheng XIE
1
;
Yongqin GE
1
;
Liyan MIAO
1
;
Zhengming JIN
1
Author Information
1. 215006,苏州大学附属第一医院药学部
- Publication Type:Journal Article
- Keywords:
Methotrexate;
Acute kidney injury;
Safety
- From:
Adverse Drug Reactions Journal
2017;19(4):277-281
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the function of "high-dose methotrexate (HD-MTX) protocol" in the patients with HD-MTX-induced acute kidney injury (AKI).Methods The medical record data of patients with hematological malignancy received HD-MTX therapy in the First Affiliated Hospital of Soochow University from January 2013 to December 2016 were collected and retrospectively analyzed.The patients who received chemotherapy before the establishment of "HD-MTX protocol" were enrolled into the control group (between January 2013 to September 2014), and the patients who received chemotherapy after the establishment of "HD-MTX protocol" were enrolled into the observation group (between October 2014 to December 2016).The incidence of delayed MTX elimination and AKI between the 2 groups were compared.Results A total of 234 patients were enrolled in the study.There were 78 patients in the control group including 50 males and 28 females with the age 3 to 64 years and median age 25 years, of them, 57 patients with leukemia and 21 patients with lymphoma.There were 156 patients in the observation group including 92 males and 64 females with the age 6 to 64 years and median age 26 years, of them, 129 patients had leukemia and 27 patients had lymphoma.The percentage of patients with no-prehydration and no-preurine alkalinization in the control group was higher than that in the observation group[60.1% (47/78) vs.4.5% (7/156), 80.8% (63/78) vs.8.3% (13/156)], and the median volume of intravenous hydration was less than that in the observation group[0 (0-500) ml vs.1 750 (1 250-2 100) ml].The differences between the 2 groups were statistically significant (X2=91.168, P<0.001;X2=124.415, P<0.001;Z=-9.224, P<0.001).The incidence of delayed MTX elimination and AKI after MTX infusion in the control group was higher than that in the observation group [21.8% (17/78) vs.12.2% (18/156).20.5% (16/78) vs.10.3% (16/156)].The differences between the 2 groups were statistically significant (X2=4.300, P=0.038;X2=4.634, P=0.031).In the control group, there were 16 patients with AKI, the patients with grade Ⅰ, grade Ⅱ and grade Ⅲ were 6, 2 and 8 respectively.In the observation group, there were 16 patients with AKI, the patients with grade Ⅰ, grade Ⅱ and grade Ⅲ were 11, 4 and 1 respectively.The degree of kidney injury in the control group was higher than that in the observation group (Z=-2.286, P=0.022).Conclusion The "HD-MTX protocol" can significantly decrease the incidence of delayed MTX elimination and AKI, especially the incidence of grade Ⅲ AKI.
