Reduced time for urinary alkalinization before high-dose methotrexate with preadmission oral bicarbonate

Reduced time for urinary alkalinization before high-dose methotrexate with preadmission oral bicarbonate

Purpose: Hydration and urinary alkalinization are essential for reducing renal dysfunction with high dose methotrexate (HDMTX). This report presents an analysis of institutional methods used to achieve adequate urinary alkalinization and output for patients receiving single agent HDMTX. Renal and me...

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Bibliographic Details
Published in:Journal of oncology pharmacy practice Vol. 18; no. 2; pp. 239 - 244
Main Authors: Kintzel, Polly E, Campbell, Alan D, Yost, Kathleen J, Brinker, Brett T, Arradaza, Nicole V, Frobish, Daniel, Wehr, Alison M, O’Rourke, Timothy J
Format: Journal Article
Language:English
Published: London, England SAGE Publications 01-06-2012
Sage Publications Ltd
Subjects:
Acute Kidney Injury - chemically induced
Acute Kidney Injury - prevention & control
Acute Kidney Injury - urine
Administration, Oral
Aged
Bicarbonates - administration & dosage
Chemotherapy
Diagnostic Tests, Routine - methods
Diagnostic Tests, Routine - trends
Female
Humans
Kidneys
Length of Stay - trends
Lymphoma
Male
Methotrexate - administration & dosage
Methotrexate - adverse effects
Methotrexate - urine
Middle Aged
Oncology
Pharmacology
Retrospective Studies
Time Factors
Toxicity
Urinalysis - methods
Urine
parenteral
nonHodgkin
infusions
drug toxicity
quality improvement
lymphoma
Methotrexate
sodium bicarbonate
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Summary:Purpose: Hydration and urinary alkalinization are essential for reducing renal dysfunction with high dose methotrexate (HDMTX). This report presents an analysis of institutional methods used to achieve adequate urinary alkalinization and output for patients receiving single agent HDMTX. Renal and metabolic parameters of tolerance were examined. Methods: Medical records of adult patients receiving HDMTX during the calendar years of 2008–2009 were retrospectively reviewed to determine the time to achieve urine pH > 7. Number of hospital days, bicarbonate dose, ordered hydration rate, urine output, and urine pH were assessed. A survival analysis model was run for time to urine pH > 7 using preadmission oral bicarbonate as a predictor variable and including a frailty term. Observational statistics were performed for other parameters. Results: The analysis included 79 encounters for ten patients. Urine pH > 7 was achieved more rapidly in patients receiving preadmission oral bicarbonate (P = 0.012). The number of patients receiving HDMTX on the same day as admission was greater for those receiving preadmission oral bicarbonate (47%) in comparison to those who did not (2%), and they spent less time in the hospital. A standard regimen for hydration and urinary alkalinization based on this project is reported. The nature and frequency of adverse events were as expected for this treatment. Conclusion: At our institution, the time to achieve urinary alkalinization was reduced for patients receiving preadmission oral bicarbonate which facilitated chemotherapy infusion on the same day as admission and decreased the number of calendar days that patients stayed in the hospital.
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ISSN:1078-1552
1477-092X
DOI:10.1177/1078155211426913