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To analyze the occurrence and risk factors of acute kidney injury (AKI) in patients with hematologic malignancies who experienced severe delayed excretion after high-dose methotrexate (HD-MTX) chemotherapy, and to explore dose adjustment strategies for reusing HD-MTX in these patients.
A retrospective analysis was conducted on clinical data of hematologic malignancy patients treated with HD-MTX in the hematology and oncology departments. Patients with severe delayed MTX excretion (defined as serum MTX >30 μmol·L-1 at 24 h, >3 μmol·L-1 at 48 h, >0.3 μmol·L-1 at 72 h, or prolonged low-level MTX >0.3 μmol·L-1 for >6 days) were included. Patients were divided into three groups based on AKI severity, group A was mild AKI, group B was moderate AKT, group C was severe AKI. Statistical methods were used to analyze risk factors for severe excretion delay and AKI.
Among 26 patients (28 HD-MTX cycles) with severe delayed excretion, AKI occurred in all cycles (100.00%). Group A accounted for 21.43% (6 cases/28 cases), Group B accounted for 46.43% (13 cases/28 cases), accounted for 32.14% (9 cases/28 cases). Pre-treatment albumin levels in group A, group B and group C were (42.22±4.63), (39.08±4.3) and (35.25±4.19) g·L-1. Among patients with moderate/severe AKI, 11 received 19 subsequent HD-MTX cycles at reduced doses (1/3-1× original), with no recurrence of excretion delay or AKI.
Low pre-treatment albumin levels, particularly <35 g·L-1 are strongly associated with severe MTX-related AKI. Patients with a history of MTX-induced AKI can safely reuse HD-MTX at adjusted doses (based on renal recovery and clinical indicators) without AKI recurrence.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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