Diskin Charles J, Stokes Thomas J, Dansby Linda M, Radcliff Lautrec, Carter Thomas B
HNDT, Auburn University, Opelika, Alabama 36801, USA.
Am J Med Sci. 2006 Sep;332(3):156-8. doi: 10.1097/00000441-200609000-00013.
Although methotrexate is highly bound to albumin, it is thought to be removed by hemodialysis and not by peritoneal dialysis. We are not aware of any direct comparison in the same patient.
CASE REPORT/METHODS: A 60-year-old patient on continuous ambulatory peritoneal dialysis was admitted to the East Alabama Medical Center for stomatitis and pancytopenia after being given 10 mg of methotrexate for his rheumatoid arthritis. Measurements of total methotrexate levels were made before, during, and after sequential peritoneal and hemodialysis treatments.
We found that the clearance of methotrexate measured in the dialysate was equal in the first hour of dialysis for both types of dialysis, although serum levels were markedly lower in hemodialysis compared to peritoneal dialysis.
Methotrexate was cleared by peritoneal dialysis in the first hour of an exchange and was not associated with a rebound in serum levels. Hemodialysis was associated with lower serum levels; however, there was also a significant rebound 2 hours after the procedure ended. Since neither procedure was able to preclude the death of the patient, other more effective means of methotrexate elimination should be employed.
尽管甲氨蝶呤与白蛋白高度结合，但一般认为它可通过血液透析而非腹膜透析清除。我们尚未知晓在同一患者身上进行的任何直接比较。
病例报告/方法：一名60岁持续非卧床腹膜透析患者因类风湿关节炎接受10毫克甲氨蝶呤治疗后，因口腔炎和全血细胞减少症入住东阿拉巴马医疗中心。在序贯腹膜透析和血液透析治疗前、治疗期间及治疗后测量了甲氨蝶呤的总水平。
我们发现，两种透析方式在透析的第一小时，透析液中甲氨蝶呤的清除率相等，尽管血液透析时的血清水平相比腹膜透析明显更低。
在交换的第一小时，腹膜透析可清除甲氨蝶呤，且血清水平不会出现反弹。血液透析与较低的血清水平相关；然而，在该程序结束2小时后也出现了显著的反弹。由于两种方法均无法避免患者死亡，应采用其他更有效的甲氨蝶呤清除方法。
