Abstract
Background: Data on short and long term renal outcomes after high dose methotrexate (HD MTX) in large adult cohorts using a standardized definition of AKI is lacking. This is a report on the incidence of AKI after HD MTX, renal outcomes when HD MTX is continued after AKI, and long term renal function in patients who survived beyond 5 years after Risk factors for AKI following HD MTX were also examined. Methods: In this single center retrospective case control study, all adult patients (>18 years) who had received HD MTX (defined as >1g/m 2 ) from 2003 – 2013 were analyzed. AKI was identified by a > 1.5x increase in baseline serum creatinine (Cr) within 4 days after HD MTX. We have collected age at first HD MTX, race, cancer, baseline and all Cr values after HD MTX, and cumulative dose (CD) of MTX. Univariable and multivariable logistic regression models were performed with AKI as the dependent variables. Overall survival for patients that had received HD MTX was presented in a Kaplan-Meier analysis. Findings: In a cohort of 865,32.1% developed AKI. Patients who developed AKI had a lower baseline Cr (0.7 ± 0.2 vs 0.9 ±0.2; p<0.001), a higher eGFR (95.1 ± 21.8 vs 90.0 ± 22.0; p<0.001) and received a higher CD (25,750 (14100 – 35000) vs 20,000 (9425 – 34,300); p<0.01). There was no statistical difference in overall survival among patients who developed AKI (p=0.13) and those who continued to receive HD MTX after AKI (p=0.32). Recovery from AKI to within 20% of baseline Cr was associated with a higher probability of survival (p<0.001). Interpretation: Despite its relatively common incidence in adult patients receiving HD MTX, AKI does not affect overall survival and should not be a barrier to further administration of chemotherapy. Funding Statement: This study was funded by NIH/NCI Cancer Center Support Grant P30 CA008748. Declaration of Interests: None to declare. Ethics Approval Statement: This study was approved by the Internal Review Board at Memorial Sloan Kettering Cancer Center, retrospective data was collected on all adult patients (>18 years) who received HD MTX from 01/01/2003 – 12/31/2013.
Published Version
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