Clinical Dilemma Over Low-dose Methotrexate Therapy in Dialysis Patients: a Case Report and Review of Literature

Authors

  • Wen-Cheng Liu Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan Author
  • Hsiang-Cheng Chen Division of Rheumatology, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan Author
  • Jin-Shuen Chen Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan Author

Abstract

Myelosuppression is the life-threatening adverse effect of methotrexate. Impaired kidney function is a major aggravating factor of methotrexate-induced myelosuppression. In end-stage renal disease patients, methotrexate therapy must be with cautious because the efficacy of removal of methotrexate by means of dialysis is in doubt. In clinical practice, low-dose methotrexate is still used by clinicians in treatment of dialysis patients with immunological disorders. We reported a 61-year-old woman on continued ambulatory peritoneal dialysis who developed pancytopenia with a nadir leukocyte count of 0.03 × 109/L, leading to severe sepsis after 3 doses of methotrexate, 7.5 mg weekly. We highlighted that methotrexate therapy in dialysis patients, even with low doses could impose the risk of myelosuppression, causing a fatal outcome. Alternative medications to methotrexate might be recommended in dialysis patients.

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Published

2014-01-04

Issue

Section

CASE REPORT | Dialysis

How to Cite

Clinical Dilemma Over Low-dose Methotrexate Therapy in Dialysis Patients: a Case Report and Review of Literature. (2014). Iranian Journal of Kidney Diseases, 8(1), 81-84. https://ijkd.org/index.php/ijkd/article/view/1114