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Methotrexate For Rheumatoid Arthritis Patients Who Are On Hemodialysis PDF
Methotrexate For Rheumatoid Arthritis Patients Who Are On Hemodialysis PDF
Methotrexate For Rheumatoid Arthritis Patients Who Are On Hemodialysis PDF
DOI 10.1007/s00296-011-2041-5
REVIEW ARTICLE
Received: 18 February 2011 / Accepted: 10 July 2011 / Published online: 22 July 2011
Springer-Verlag 2011
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doses of MTX such as 2.5 mg, if not fatal in this cohort can
cause severe pancytopenia for several weeks with placement in a sterile room as even the immunosuppression of
low-dose MTX can lead to opportunistic infection [10, 11].
Since the pharmacokinetics of patients with both RA
and renal disease have not been studied, no dosing recommendations are available as of yet. Some authors suggest that MTX should be reduced to 2.5 mg/week in these
patients while some have based their recommendation
based on creatinine clearance most notably with a creatinine clearance of less than 10 mL/min while others say it is
contraindicated in any patient with a creatinine clearance
of less than 50 mL/min [2].
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Conclusion
There are an increasing number of clinicians that recommend not prescribing MTX to dialysis patients even at low
doses. This increase in toxicity is more notable in terms of
bone marrow suppression. Many methods of elimination
have been proven ineffective, and prospective methods still
require much research.
The effects of ESRD in MTX-induced pancytopenia can
be separated into three groups. Directly through compromised function, indirectly through HD and risk factor
drugs, and independent factors, whether that be attributes
or concomitant illnesses to ESRD that increase the severity
of pancytopenia. All three of these groups contribute to the
difficulty in determining safe MTX dosages and it becomes
even harder to predict leaving us with the adage it is
better to be safe than sorry.
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References
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1. Owen WF, Lew NL, Liu Y, Lowrie EG (1993) The urea reduction ratio and serum albumin concentration as predictors of
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