eISSN: 2345-4202  
J Nephropharmacol. 2018;7(2):74-79.

Original

Renal function as a predicting model for plasma methotrexate concentration after high-dose methotrexate chemotherapy in pediatric malignancy

Kaveh Jaseb 1, Ehsan Ghaedi 2,1, Mohadeseh Shahin 3, Majid Mirmohamadkhani 4, Parisa Javadian 5, Sabahat Haghi 3 *

1 Thalassemia and Hemoglobinopathies Research Centre, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
2 Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Pediatrics (Hematology and Oncology), AmiralmomeninMedical, Educational Center, Semnan University of Medical Sciences, Semnan, Iran
4 Department of Community Medicine, Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
5 Department of Internal Medicine, School of Medicine, Shahrekord University of Medical Sciences; Shahrekord, Iran
*Corresponding author: Sabahat Haghi, Email: Email: SABAHAGHI@yahoo.com

Abstract

Introduction: Methotrexate (MTX) is the most generally administered antimetabolite in pediatric cancers. Renal excretion is the major route of elimination of MTX. However, renal toxicity and delayed MTX elimination is a particular concern and direct serum MTX concentration is a gold standard for renal toxicity monitoring. However, checking plasma MTX concentrations in most oncology institutions is not always possible especially in less developed countries.

Objectives: The purpose of this study was to further assess the renal function after administration of high-dose MTX by parameters such as serum creatinine and Cr clearance rate.

Patients and Methods: This is a cross-sectional descriptive analytic study. The study was conducted on children with acute lymphoblastic leukemia, non-Hodgkin lymphoma and osteosarcoma receiving high doses MTX. Patients’ age was ranged from 5 to 16 years. Serum MTX concentration and serum Cr were measured at 24, 48 and 96 hours after receiving MTX and then Cr clearance calculated based on available formulas. All the statistical analyses were done by SPSS 20.0 statistical software

Results: This study was performed on 4 patients with osteosarcoma, 3 patients with leukemia and one patient with lymphoma. MTX concentration reduced significantly during 96 hours (P<0.001). A significant correlation between Cr clearance at 48 hours and the average of serum MTX concentration (P=0.001) were observed. Furthermore there were significant correlations between Cr at 24 hours (P=0.003), 48 hours (P=0.009) and 96 hours (P=0.044), with the average of serum MTX concentration.

Conclusion: Our findings indicated that serum Cr and Cr clearance can be used to estimate the average of serum MTX concentrations.

Implication for health policy/practice/research/medical education:

Predicting the possible side effects of methotrexate, play an important role during chemotherapy regimens. If predicted dose reduced because of unfavorable side effects, not only chemotherapy regimens may fail but also the risk of relapse increase. Nephrotoxicity is one of important side effect of this drug. Thus possible model for predicting renal function after high-dose methotrexate therapy could prevent adverse outcomes.

Please cite this paper as: Jaseb K, Ghaedi E, Shahin M, Mirmohamadkhani M, Javadian P, Haghi S. Renal function as a predicting model for plasma methotrexate concentration after high-dose methotrexate chemotherapy in pediatric malignancy. J Nephropharmacol. 2017;7(2):74-79. 

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Submitted: 07 Jul 2017

Accepted: 13 Nov 2017
First published online: 24 Nov 2017
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