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Impact of Low-Dose Methotrexate on Estimated Glomerular Filtration Rate

  • 1 Bhavna Bhasin-Chhabra, MD, is with the Division of Nephrology, Medical College of Wisconsin, Milwaukee. Juan Carlos Q. Velez, MD, is with the Department of Nephrology, Ochsner Clinic Foundation, New Orleans, LA, and Ochsner Clinical School, The University of Queensland, Brisbane, Australia.
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Methotrexate (MTX) has been used for treatment of connective tissue disorders, including rheumatoid arthritis. In much higher doses, MTX is used for various hematologic and oncologic disorders (1). Renal elimination accounts for 70%−90% of the clearance of MTX (2). High-dose intravenous MTX has the potential for causing kidney injury by crystal precipitation within the renal tubules (3, 4). In addition, oral MTX can potentially accumulate in patients with reduced kidney function and lead to toxic effects, such as myelosuppression and hepatotoxicity (5). However, although MTX is contraindicated in patients with

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