Analysis of the therapeutic effect of online haemodiafiltration on delayed methotrexate excretion combined with acute kidney injury in children: a real-world study.

BACKGROUND

To evaluate the efficacy and feasibility of online haemodiafiltration (HDF) in the treatment of delayed methotrexate (MTX) excretion and acute kidney injury (AKI) in children with hematological malignancies after chemotherapy.

METHODS

Children diagnosed with hypermethotrexatemia combined with acute kidney injury and receiving blood purification treatment during high-dose methotrexate(HD-MTX) chemotherapy for leukemia/lymphoma in a hospital from January 2019 to August 2023 were divided into CRRT group and HDF group. The rate of decrease in MTX blood concentration, drug-related adverse reactions, renal function recovery time and hospitalization related economic costs were compared between the HDF group and CRRT group.

RESULTS

There was no significant differences ( > 0.05) between the HDF group and the CRRT group in terms of drug concentration after 45 h of MTX treatment, time required for MTX concentration to return to normal, time required for renal function to return to normal, length of hospital stay and the primary clinical endpoints between HDF and CRRT groups. In terms of total hospitalization costs and blood purification related expenses, the HDF group was significantly lower than the CRRT group ( < 0.05).

CONCLUSION

In children with hypermethotrexatemia and AKI who cannot effectively clear MTX through conservative internal medicine treatment. online HDF appears to be a safe and cost-effective alternative to CRRT for MTX clearance in paediatric patients with delayed excretion and AKI, with similar clinical outcomes and lower associated costs.

CLINICAL TRIAL NUMBER

Not applicable.