Effective removal of methotrexate by high-flux hemodialysis

Jeffrey M. Saland, Patrick J. Leavey, Robert O. Bash, Eleonora Hansch, Gerald S. Arbus, Raymond Quigley

Research output: Contribution to journalArticlepeer-review

61 Scopus citations


The purpose of the present study was to examine the clearance of methotrexate (MTX) by high-flux hemodialysis (HD) in pediatric oncology patients. We present three patients who experienced nephrotoxicity and prolonged exposure to toxic MTX concentrations following high-dose infusions during treatment for osteogenic sarcomas. Each patient was successfully treated with high-flux HD, followed by carboxypeptidase G2 (CPDG2) in two cases. Minimal systemic toxicity occurred. We review the literature and discuss guidelines for early and aggressive treatment for this complication of high-dose MTX therapy. Clinically important removal of MTX depends upon prompt initiation of HD after detection of nephrotoxicity and delayed clearance of MTX. Therapy is indicated in cases where compassionate use of CPDG2 may not be available, or while awaiting its delivery.

Original languageEnglish (US)
Pages (from-to)825-829
Number of pages5
JournalPediatric Nephrology
Issue number10
StatePublished - Dec 1 2002


  • Antineoplastic-antimetabolites
  • Bone neoplasms
  • Hemodialysis
  • Toxicology

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology


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