{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T02:06:34Z","timestamp":1792202794500,"version":"4.4.0"},"reference-count":19,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T00:00:00Z","timestamp":1634688000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Oncol Pharm Pract"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Acute kidney injury (AKI) after high dose methotrexate (HD-MTX) is associated with delayed MTX-excretion and life-threatening toxicity. Glucapridase, the recommended therapy, is expensive and not always available.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case series<\/jats:title>\n                    <jats:p>We describe 3 cases (69, 67, 73 years) with diffuse large B-cell lymphoma who developed AKI and early-onset severely delayed MTX elimination after HD-MTX. MTX serum concentrations were 101 and 69\u2005\u03bcmol\/L at 24\u2005h after administration in two patients and 34\u2005\u03bcmol\/L at 32\u2005h in the third.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Management and outcome<\/jats:title>\n                    <jats:p>Since glucarpidase was unavailable, we performed daily high-flux hemodialysis (HF-HD) or online hemodiafiltration (HDF) sessions (median duration, 6\u2005h). The median serum MTX elimination half-life during HDF\/HF-HD sessions was similar in all patients (median, 4.4\u2005h; IQR, 3.8\u20135.3\u2005h), but serum MTX concentrations rebounded after each dialysis by a median of 40% of the trough concentrations. The three patients underwent multiple dialysis sessions, until MTX serum concentrations remained sufficiently low to be neutralized by leucovorin. Only 1 patient developed severe pancytopenia, and renal function normalized in all patients after 3\u20136 weeks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>In conclusion, when glucarpidase is unavailable or delayed, early, repeated and prolonged HDF\/HF-HD effectively enhance MTX elimination and prevent toxicity in patients with AKI and severely delayed MTX elimination after HD-MTX.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10781552211052564","type":"journal-article","created":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T15:42:02Z","timestamp":1634744522000},"page":"508-515","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["Effective elimination of high-dose methotrexate by repeated hemodiafiltration and high-flux hemodialysis in patients with acute kidney injury"],"prefix":"10.1177","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4286-1370","authenticated-orcid":false,"given":"Razan","family":"Sakran","sequence":"first","affiliation":[{"name":"Section of Clinical Pharmacology and Toxicology, Rambam Health Care Campus, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gai","family":"Milo","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Rambam Health Care Campus, Haifa, Israel"},{"name":"Rappaport Faculty of Medicine, Technion \u2013 Israel Institute of Technology, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Jabareen","sequence":"additional","affiliation":[{"name":"Section of Clinical Pharmacology and Toxicology, Rambam Health Care Campus, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tareq","family":"Artul","sequence":"additional","affiliation":[{"name":"Section of Clinical Pharmacology and Toxicology, Rambam Health Care Campus, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nissim","family":"Haim","sequence":"additional","affiliation":[{"name":"Department of Oncology, Rambam Health Care Campus, Haifa, Israel"},{"name":"Rappaport Faculty of Medicine, Technion \u2013 Israel Institute of Technology, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Litvak","sequence":"additional","affiliation":[{"name":"Department of Oncology, Rambam Health Care Campus, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shimrit","family":"Ringelstein-Harlev","sequence":"additional","affiliation":[{"name":"Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nethanel","family":"Horowitz","sequence":"additional","affiliation":[{"name":"Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edna","family":"Efrati","sequence":"additional","affiliation":[{"name":"Section of Clinical Pharmacology and Toxicology, Rambam Health Care Campus, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suheir","family":"Assady","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Rambam Health Care Campus, Haifa, Israel"},{"name":"Rappaport Faculty of Medicine, Technion \u2013 Israel Institute of Technology, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Kurnik","sequence":"additional","affiliation":[{"name":"Section of Clinical Pharmacology and Toxicology, Rambam Health Care Campus, Haifa, Israel"},{"name":"Rappaport Faculty of Medicine, Technion \u2013 Israel Institute of Technology, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,10,20]]},"reference":[{"key":"bibr1-10781552211052564","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2015-0164"},{"key":"bibr2-10781552211052564","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-20790-2_109-1"},{"key":"bibr3-10781552211052564","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6602337"},{"key":"bibr4-10781552211052564","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.25.4540"},{"key":"bibr5-10781552211052564","doi-asserted-by":"publisher","DOI":"10.1177\/2399369319827305"},{"key":"bibr6-10781552211052564","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.25395"},{"key":"bibr7-10781552211052564","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.20255"},{"key":"bibr8-10781552211052564","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-6386(96)90384-4"},{"key":"bibr9-10781552211052564","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-002-0946-7"},{"key":"bibr10-10781552211052564","first-page":"66","volume":"2","author":"Mutsando 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