大剂量甲氨蝶呤治疗恶性血液系统肿瘤中排泄重度延迟并发急性肾损伤的临床研究OA

Objective To analyze the occurrence and risk factors of acute kidney injury(AKI)in patients with hematologic malignancies who experienced severe delayed excretion after high-dose methotrexate(HD-MTX)chemotherapy,and to explore dose adjustment strategies for reusing HD-MTX in these patients.Methods A retrospective analysis was conducted on clinical data of hematologic malignancy patients treated with HD-MTX in the hematology and oncology departments.Patients with severe delayed MTX excretion(defined as serum MTX＞30 μmol·L-1 at 24 h,＞3 μmol·L-1 at 48 h,＞0.3 μmol·L-1 at 72 h,or prolonged low-level MTX＞0.3 μmol·L-1 for＞6 days)were included.Patients were divided into three groups based on AKI severity,group A was mild AKI,group B was moderate AKT,group C was severe AKI.Statistical methods were used to analyze risk factors for severe excretion delay and AKI.Results Among 26 patients(28 HD-MTX cycles)with severe delayed excretion,AKI occurred in all cycles(100.00％).Group A accounted for 21.43％(6 cases/28 cases),Group B accounted for 46.43％(13 cases/28 cases),accounted for 32.14％(9 cases/28 cases).Pre-treatment albumin levels in group A,group B and group C were(42.22±4.63),(39.08±4.3)and(35.25±4.19)g·L-1.Among patients with moderate/severe AKI,11 received 19 subsequent HD-MTX cycles at reduced doses(1/3-1 × original),with no recurrence of excretion delay or AKI.Conclusion Low pre-treatment albumin levels,particularly＜35 g·L-1 are strongly associated with severe MTX-related AKI.Patients with a history of MTX-induced AKI can safely reuse HD-MTX at adjusted doses(based on renal recovery and clinical indicators)without AKI recurrence.