{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T07:33:04Z","timestamp":1770967984418,"version":"3.50.1"},"reference-count":23,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2022,4,21]],"date-time":"2022-04-21T00:00:00Z","timestamp":1650499200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The standard practice to mitigate high\u2010dose methotrexate (HD\u2010MTX)\u2013induced nephrotoxicity (HMN) in acute lymphoblastic leukemia (ALL) is to monitor levels until serum MTX falls below a predefined threshold. It is not feasible in most resource\u2010constrained centers. Literature on the various factors affecting HMN in these centers is limited, retrospective, and heterogeneous. Though hypoalbuminemia has been postulated as a risk factor for HMN, the relationship of undernutrition with HMN has not been studied.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>This prospective observational study consecutively enrolled children\u00a0&lt;\u00a012 years old with ALL receiving HD\u2010MTX. Children with preexisting renal disease and exposed to nephrotoxic drugs two weeks preceding HD\u2010MTX infusion were excluded. HD\u2010MTX was administered over 24 hours (BFM\u20102009 protocol) with 12 hours of prehydration. Solitary MTX levels at 36 hours (MTX36) were outsourced, and 6\u20108 doses of leucovorin were given six\u2010hourly. Hydration was continued till last dose of leucovorin. Various factors affecting HMN (rise in creatinine to 1.5 times baseline) were recorded: age, sex, type of ALL, risk group of ALL, first dose of MTX, dose of MTX, undernourishment, serum protein, and albumin along with C\u2010reactive protein and MTX36 levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010four children who received 150 HD\u2010MTX cycles were analyzed. HMN was seen in 14% of cycles. On univariate analysis, undernourishment, MTX36 levels, hypoproteinemia, and hypoalbuminemia were significantly associated with HMN. On multivariate analysis, hypoalbuminemia and MTX36 levels significantly predicted the development of HMN with odds ratios of 4.71 and 1.45.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Hypoalbuminemia and solitary serum MTX levels predict HMN in centers where serial MTX level monitoring is not feasible.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.29738","type":"journal-article","created":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T05:14:00Z","timestamp":1650604440000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Hypoalbuminemia and not undernutrition predicts high\u2010dose methotrexate\u2010induced nephrotoxicity in children with acute lymphoblastic leukemia in resource\u2010constrained centers"],"prefix":"10.1002","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4754-8340","authenticated-orcid":false,"given":"Sanjeev","family":"Khera","sequence":"first","affiliation":[{"name":"Department of Pediatrics Army Hospital Research and Referral  Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaurav","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Army Hospital Research and Referral  Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vandana","family":"Negi","sequence":"additional","affiliation":[{"name":"Brig Med HQ CC  Lucknow Uttar Pradesh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Subhash Chandra","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Army Hospital Research and Referral  Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,4,21]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-04-1616"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2401973"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2015-0164"},{"issue":"2","key":"e_1_2_7_5_1","first-page":"100","article-title":"Identification of risk factors in high\u2010dose methotrexate\u2010induced acute kidney injury in childhood acute lymphoblastic leukemia","volume":"63","author":"Cheng D\u2010H","year":"2018","journal-title":"CHE"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.28387"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00280-002-0552-1"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/hon.2759"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.2147\/CMAR.S207959"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13312-015-0642-x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.3945\/an.110.000141"},{"key":"e_1_2_7_12_1","unstructured":"CampbellDM ALL IC\u2010BFM 2009: Trial steering committee.2009;178."},{"key":"e_1_2_7_13_1","unstructured":"methotrexate\u2010level.pdf [Internet]. 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