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UK-VRX-2600029 Date of Last Revision: February 2026

Delayed MTX elimination
& risks factors

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Abbreviations: AKI, acute kidney injury; HDMTX, high dose methotrexate; IV, intravenous; MTX, methotrexate.

HDMTX-INDUCED NEPHROTOXICITY

  • May lead to delayed MTX elimination
  • Resulting in sustained elevated plasma MTX concentrations3

Patient RISK FACTORS FOR DELAYED MTX ELIMINATION2,3

Nephrotoxic pharmacodynamic interactions
Body mass index (BMI) ≥25 kg/m2
Renal insufficiency prior to HDMTX
Prior toxicity with HDMTX
Adult and elderly patients
Volume depletion (vomiting, diarrhoea)
Third spacing (pleural effusions, ascites, intracranial fluid)
Polyuria, urine pH <7, creatinine clearance (CrCl) <60 mL/min

Abbreviations: BMI, body mass index; CrCl, creatinine clearance; HDMTX, high dose methotrexate; MTX, methotrexate.

Delayed MTX elimination increases the risk of systemic toxicity

Delayed MTX elimination can lead to potentially

IRREVERSIBLE LIFE-THREATENING

SYSTEMIC TOXICITY AND ORGAN DAMAGE.1,2,3,5

AKI-Image-New

Abbreviations: AKI, acute kidney injury; GI, gastrointestinal; HDMTX, high dose methotrexate; MTX, methotrexate.

References

  1. Ramsey LB, et al. Consensus guideline for use of glucarpidase in patients with high-dose methotrexate induced acute kidney injury and delayed methotrexate clearance. Oncologist. 2018;23(1):52-61.
  2. Howard SC, et al. Preventing and managing toxicities of high-dose methotrexate. Oncologist. 2016;21(12):1471-82.
  3. Widemann BC, Adamson PC. Understanding and managing methotrexate nephrotoxicity. Oncologist. 2006;11(6):694-703.
  4. Schwartz S, et al. Glucarpidase (carboxypeptidase G2) intervention in adult and elderly cancer patients with renal dysfunction and delayed methotrexate elimination after high-dose methotrexate therapy. Oncologist. 2007;12(11):1299-308.
  5. Widemann BC, et al. Glucarpidase, leucovorin, and thymidine for high-dose methotrexate-induced renal dysfunction: clinical and pharmacologic factors affecting outcome. J Clin Oncol. 2010;28(25):3979-86.
  6. Silver SA, Siew ED. Follow-up care in acute kidney injury: lost in transition. Adv Chronic Kidney Dis. 2017;24(4):246-52.

UK-VRX-2600031 Date of Last Revision: February 2026