Methotrexate clearance by high-flux hemodialysis and peritoneal dialysis: a case report

Am J Kidney Dis. 2009 May;53(5):871-4. doi: 10.1053/j.ajkd.2009.01.016. Epub 2009 Apr 1.


We report a case of a patient on maintenance peritoneal dialysis therapy treated with a high-dose methotrexate regimen for central nervous system lymphoma. For the initial methotrexate cycles, he had received temporary daily high-flux hemodialysis starting 24 hours after the infusion of methotrexate to avoid toxicity. However, on account of issues with vascular access, he was treated with continuous multiple-exchange peritoneal dialysis for the last 2 cycles of chemotherapy. Time-averaged clearances (dose divided by area under the curve, combination of endogenous and dialysis clearance) during treatment with high-flux hemodialysis and continuous multiple-exchange peritoneal dialysis were 0.77 mL/min/kg (0.013 mL/s/kg) and 0.65 mL/min/kg (0.011 mL/s/kg), respectively. Peritoneal clearance of methotrexate was estimated to be 0.124 +/- 0.037 mL/min/kg (0.00207 +/- 0.00062 mL/s/kg). Despite lower clearance by means of peritoneal dialysis compared with hemodialysis, the patient did not develop clinical evidence of methotrexate toxicity.

Publication types

  • Case Reports

MeSH terms

  • Dialysis Solutions / analysis
  • Follow-Up Studies
  • Humans
  • Immunosuppressive Agents / pharmacokinetics*
  • Immunosuppressive Agents / therapeutic use
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / metabolism
  • Kidney Failure, Chronic / therapy*
  • Lymphoma, Large B-Cell, Diffuse / complications
  • Lymphoma, Large B-Cell, Diffuse / drug therapy*
  • Lymphoma, Large B-Cell, Diffuse / metabolism
  • Male
  • Metabolic Clearance Rate
  • Methotrexate / pharmacokinetics*
  • Methotrexate / therapeutic use
  • Middle Aged
  • Peritoneal Dialysis / methods*


  • Dialysis Solutions
  • Immunosuppressive Agents
  • Methotrexate