Title: Advancement in improving adherence to Hypertensive medication

Biography:

Hasan Arif is an associate professor of Medicine at Drexel University where he is the Director of CME for Medicine and Nephrology and the Co- director for the Drexel Hypertension Center. He is a graduate of Dow Medical College and completed his Residency and Fellowship at Drexel.

Abstract

Introduction: Methotrexate (MTx) is widely used in high doses in a variety of cancers. Dosing is followed by leucovorin, alkalinization and hydration to avoid toxicity which still occurs in 1.8% ¹ of cases. Haemodialysis (RRT) has been used to rapidly reduce the level of MTx.

Cases Summary

Patient A: 60 yo man with past medical history (PMHx) of stage 3 diffuse large B-cell lymphoma was admitted for chemotherapy (Cycle 3 day 6 of Rituxan + MTx + Cytarabine). His admission creatinine was 0.72 mg/dl. He received MTX 900mg over 15 minutes then 5500 mg over 3 hours. On day 3 of receiving MTx patient’s creatinine increased to 1.83 mg/dl with oligouira and MTx level of 44 μmol. Patient had one session of haemodialysis immediately after the peak level of MTX of 44 μmol. MTx level came down to 0.14 μmol without requiring further haemodialysis sessions. Creatinine remained stable between 1.3- 1.6 mg/dl with good urine output. Renal function stabilized at 0.8 mg/dL with MTx level of 0.08μmol.

Patient B: 55 yo AAM with PMHx of hepatitis C, bipolar disorder and active heroin/cocaine abuse was diagnosed with T- cell acute lymphoblastic lymphoma. He received four doses of MTx (6,000 mg). Over the next 3 days, creatinine worsened from 0.77 > 1.38 > 3.25 > 4.16 mg/dl in the setting of elevated MTX level. Patient received IVF, urinary alkalinization and maximum dose leucovorin. Patient developed oliguric and volume overload. With concern for extra- renal toxicity he was initiated on CVVHD. He remained on RRT for 17 days despite receiving glucarpidase.

Discussion: Early RRT in MTx toxicity is effective in reducing the duration of acute kidney injury and has better patient outcome with less resources required.