Successful multiple-exchange peritoneal dialysis in a patient with severe hematological toxicity by methotrexate: case report and literature review
Abstract Methotrexate is an effective medication to control several diseases; however, it can be very toxic, being myelosuppression one of its main adverse effects, which increases in severity and frequency in patients with renal failure. We present the case of a 68-year-old man with chronic, end-stage renal disease associated with ANCA vasculitis, under treatment with peritoneal dialysis, who received the medication at a low dose, indicated by disease activity, which presented as a complication with severe pancytopenia with mucositis that improved with support measures and multiple-exchange peritoneal dialysis. We reviewed 20 cases published to date of pancytopenia associated with methotrexate in patients on dialysis and found high morbidity and mortality, which is why its use in this type of patient is not recommended. However, when this complication occurs, a therapeutic option could be the use of multiple-exchange peritoneal dialysis in addition to supportive therapy for drug-related toxicity, although it is recognized that studies are required to show the role of multiple-exchange peritoneal dialysis in the removal of this medication.
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Sociedade Brasileira de Nefrologia
2019
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oai:scielo:S0101-280020190003004272019-09-24Successful multiple-exchange peritoneal dialysis in a patient with severe hematological toxicity by methotrexate: case report and literature reviewAristizabal-Alzate,ArbeyNieto-Rios,John FredyOcampo-Kohn,CatalinaSerna-Higuita,Lina MariaBello-Marquez,Diana CarolinaZuluaga-Valencia,Gustavo Adolfo Methotrexate Pancytopenia Renal Insufficiency Peritoneal Dialysis Abstract Methotrexate is an effective medication to control several diseases; however, it can be very toxic, being myelosuppression one of its main adverse effects, which increases in severity and frequency in patients with renal failure. We present the case of a 68-year-old man with chronic, end-stage renal disease associated with ANCA vasculitis, under treatment with peritoneal dialysis, who received the medication at a low dose, indicated by disease activity, which presented as a complication with severe pancytopenia with mucositis that improved with support measures and multiple-exchange peritoneal dialysis. We reviewed 20 cases published to date of pancytopenia associated with methotrexate in patients on dialysis and found high morbidity and mortality, which is why its use in this type of patient is not recommended. However, when this complication occurs, a therapeutic option could be the use of multiple-exchange peritoneal dialysis in addition to supportive therapy for drug-related toxicity, although it is recognized that studies are required to show the role of multiple-exchange peritoneal dialysis in the removal of this medication.info:eu-repo/semantics/openAccessSociedade Brasileira de NefrologiaBrazilian Journal of Nephrology v.41 n.3 20192019-09-01info:eu-repo/semantics/articletext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002019000300427en10.1590/2175-8239-jbn-2018-0095 |
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Aristizabal-Alzate,Arbey Nieto-Rios,John Fredy Ocampo-Kohn,Catalina Serna-Higuita,Lina Maria Bello-Marquez,Diana Carolina Zuluaga-Valencia,Gustavo Adolfo |
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Aristizabal-Alzate,Arbey Nieto-Rios,John Fredy Ocampo-Kohn,Catalina Serna-Higuita,Lina Maria Bello-Marquez,Diana Carolina Zuluaga-Valencia,Gustavo Adolfo Successful multiple-exchange peritoneal dialysis in a patient with severe hematological toxicity by methotrexate: case report and literature review |
author_facet |
Aristizabal-Alzate,Arbey Nieto-Rios,John Fredy Ocampo-Kohn,Catalina Serna-Higuita,Lina Maria Bello-Marquez,Diana Carolina Zuluaga-Valencia,Gustavo Adolfo |
author_sort |
Aristizabal-Alzate,Arbey |
title |
Successful multiple-exchange peritoneal dialysis in a patient with severe hematological toxicity by methotrexate: case report and literature review |
title_short |
Successful multiple-exchange peritoneal dialysis in a patient with severe hematological toxicity by methotrexate: case report and literature review |
title_full |
Successful multiple-exchange peritoneal dialysis in a patient with severe hematological toxicity by methotrexate: case report and literature review |
title_fullStr |
Successful multiple-exchange peritoneal dialysis in a patient with severe hematological toxicity by methotrexate: case report and literature review |
title_full_unstemmed |
Successful multiple-exchange peritoneal dialysis in a patient with severe hematological toxicity by methotrexate: case report and literature review |
title_sort |
successful multiple-exchange peritoneal dialysis in a patient with severe hematological toxicity by methotrexate: case report and literature review |
description |
Abstract Methotrexate is an effective medication to control several diseases; however, it can be very toxic, being myelosuppression one of its main adverse effects, which increases in severity and frequency in patients with renal failure. We present the case of a 68-year-old man with chronic, end-stage renal disease associated with ANCA vasculitis, under treatment with peritoneal dialysis, who received the medication at a low dose, indicated by disease activity, which presented as a complication with severe pancytopenia with mucositis that improved with support measures and multiple-exchange peritoneal dialysis. We reviewed 20 cases published to date of pancytopenia associated with methotrexate in patients on dialysis and found high morbidity and mortality, which is why its use in this type of patient is not recommended. However, when this complication occurs, a therapeutic option could be the use of multiple-exchange peritoneal dialysis in addition to supportive therapy for drug-related toxicity, although it is recognized that studies are required to show the role of multiple-exchange peritoneal dialysis in the removal of this medication. |
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Sociedade Brasileira de Nefrologia |
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2019 |
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http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002019000300427 |
work_keys_str_mv |
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