高劑量Methotrexate化療處方範本更新後常規檢測尿液酸鹼值之成效分析

Evaluation of Routine Urine pH Monitoring Before and After High-Dose Methotrexate Therapy

任婉瑜(Wan-Yu Jen) ； 王妤文(Yu-Wen Wang) ； 陳品孜(Pin-Zi Chen) ； 林星羽(Hsing-Yu Lin)

《臺灣臨床藥學雜誌》 30卷2期 (2022/04) Pp. 163-174

https://doi.org/10.6168/FJCP.202204_30(2).0008

摘要

目的：探討化療處方範本更新後，給予高劑量methotrexate（HDMTX）期間常規監測尿液pH值是否改善methotrexate排除速率、減少相關副作用發生。並評估是否可藉由病人給藥前尿液pH值預測病人HDMTX引起急性腎損傷風險。方法：此回溯性研究於2018年9月某醫學中心化療處方範本更新前後，分別收載117位及73位使用HDMTX病人。透過病歷收集資料，分析常規監測尿液pH值前後兩組急性腎損傷發生率、尿液檢測率、尿液pH值達標率（pH≥7.0）是否統計顯著差異。依據發生急性腎損傷與否進行次族群分析，探討兩組給藥前尿液pH值是否統計顯著差異並探討危險因子。結果：HDMTX化療處方範本更新後，尿液檢測率增加（30.8% vs. 68.5%, p＜0.0001）、尿液pH值達標率增加（首日6.8%vs.16.4%，p=0.03；次日1.7% vs. 21.9%，p＜0.0001），急性腎損傷發生率並無統計顯著差異（16.24% vs. 9.59%, p=0.19）。在多變項邏輯斯迴歸分析中，給藥前尿液pH值低、水腫、HDMTX劑量高、併用腎毒性藥品是HDMTX引起急性腎損傷的統計顯著影響因子。結論：HDMTX化療處方範本更新後，尿液檢測率及尿液pH值達標率皆顯著增加，急性腎損傷發生率並無統計顯著差異。給藥前尿液pH值低是HDMTX引起急性腎損傷的統計顯著影響因子之一。常規監測尿液pH值可以讓醫療團隊及時調整尿液鹼化處方，針對給藥前尿液pH值較低之病人，需及早提高尿液鹼化處方強度。

關鍵字

高劑量methotrexate ； 尿液pH值 ； 急性腎損傷

並列摘要

Objective: The study assessed the effect of urine pH monitoring on the side effects of high-dose methotrexate (HDMTX) therapy after a prescription template revision. We also determined whether baseline urine pH can predict the risk of HDMTX-induced acute kidney injury. Methods: This retrospective study included 117 and 73 patients who received, respectively, HDMTX therapy before and after the revision of a prescription template issued by a medical center in September 2018. We extracted data from the patients' medical records. The incidence of acute kidney injury, rate of urine analysis, and percentage of patients with a urine pH of ≥7.0 were analyzed. On the basis of the occurrence of acute kidney injury, a subgroup analysis was conducted to determine the risk factors. Results: After the prescription template was revised, the urine analysis rate (30.8% vs 68.5%, P ＜ 0.0001) and percentage of patients with a urine pH of ≥ 7.0 increased significantly in the first 2 days (6.8% vs 16.4%, P = 0.03; 1.7% vs 21.9%, P ＜ 0.0001). The difference in the incidence of acute kidney injury was nonsignificant (16.24% vs 9.59%, P = 0.19). A low baseline urine pH, edema, a high methotrexate dose and concomitant nephrotoxic medication were identified as risk factors for HDMTX-related acute kidney injury. Conclusions: Urine pH monitoring helps medical team adjust their alkalization regimens in a timely manner, but does not lead to a significant difference in incidence of HDMTX-related acute kidney injury. A low baseline urine pH is a risk factor for HDMTX-related acute kidney injury. For patients with a low baseline urine pH, an intensive alkalization regimen must be administered as quickly as possible.

並列關鍵字

High-Dose Methotrexate ； Urine pH ； Acute Kidney Injury