Advances in Managing Acute Kidney Injury: Improving Outcomes for Patients Treated with High-Dose Methotrexate
A Two-Part Case-Based Activity for Oncology Advanced Practitioners
High-dose methotrexate (HDMTX) continues to be used in several treatment regimens for patients with solid tumors and hematologic malignancies. Despite appropriate supportive care measures during its administration, patients receiving HDMTX are at risk of developing acute kidney injury (AKI) due to delayed clearance. Consensus guidelines were developed to help the health-care team optimize the treatment of HDMTX-induced AKI and understand at which timepoints glucarpidase is most effective. In this two-part video series, three advanced practice providers discuss strategies to monitor patients treated with HDMTX for development of AKI, the patient and disease characteristics that trigger treatment with glucarpidase, and best practices for treating HDMTX-induced AKI safely and effectively based on available evidence and guidelines.
Learning Objectives:
- Plan strategies to monitor patients treated with HDMTX for development of AKI
- Identify patient and disease characteristics that trigger treatment with glucarpidase
- Formulate plans to treat AKI caused by HDMTX safely and effectively based on best available evidence and recent guidelines
To learn more about this topic, visit Optimizing the Treatment of Acute Kidney Injury Caused by High-Dose Methotrexate: Integrating New Guidelines to Improve Patient Care
Advances in Managing Acute Kidney Injury: Improving Outcomes for Patients Treated with High-Dose Methotrexate
High-dose methotrexate (HDMTX) continues to be used in several treatment regimens for patients with solid tumors and hematologic malignancies. Despite appropriate supportive care measures during its administration, patients receiving HDMTX are at risk of developing acute kidney injury (AKI) due to delayed clearance. Advanced practice providers must understand the importance of having strategies in place to monitor patients treated with HDMTX for development of AKI, knowing the disease characteristics that trigger treatment with glucarpidase, and implementing best practices for treating HDMTX-induced AKI safely and effectively based on available evidence and guidelines.
Case Study 1: HDMTX-Induced AKI in Osteosarcoma
Faculty
Nancy Nix, PharmD, BCPS, BCOP, University of Georgia College of Pharmacy
Kristi K. Posey, PA-C, University of Texas MD Anderson Cancer Center
Release date: September 10, 2019
Expiration date: September 10, 2020
Estimated time to complete: 0.5 hour
Fee: None
Case Study 2: HDMTX-Induced AKI in CNS Lymphoma
Faculty
Nancy Nix, PharmD, BCPS, BCOP, University of Georgia College of Pharmacy
Haleigh Mistry, MS, PA-C, University of Texas MD Anderson Cancer Center
Release date: September 10, 2019
Expiration date: September 10, 2020
Estimated time to complete: 0.5 hour
Fee: None
These activities are designed to help clinicians achieve specific learning objectives, which reflect the desired results of the education. Participants are encouraged to integrate what they learn from this activity into practice to improve patient care and outcomes.
Jointly provided by
Intended Participants
These activities are designed for physician assistants (PAs), nurse practitioners (NPs), clinical nurse specialists (CNSs), and clinical oncology pharmacists (COPs), who provide care for patients treated with HDMTX.
Learning Objectives
- Plan strategies to monitor patients treated with HDMTX for development of AKI
- Identify patient and disease characteristics that trigger treatment with glucarpidase
- Formulate plans to treat AKI caused by HDMTX safely and effectively based on best available evidence and recent guidelines
Continuing Education
Certification
These activities are certified for credit by Annenberg Center for Health Sciences at Eisenhower
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Statement of Credit
Participants who successfully complete these activities—which includes submitting a completed pre-test, submitting and scoring at least 70% on the post-test, and submitting a completed evaluation form—will be able to download a statement of credit.
Click here to access the learning assessment and evaluation form for Case Study 1.
Click here to access the learning assessment and evaluation form for Case Study 2.
Accreditation and Designation Statements
Physicians. These activities have been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Annenberg Center for Health Sciences at Eisenhower and Harborside Medical Education. The Annenberg Center is accredited by the ACCME to provide continuing medical education for physicians.
The Annenberg Center for Health Sciences at Eisenhower designates these enduring activities for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Nurses. The Annenberg Center for Health Sciences at Eisenhower is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
A maximum of 0.5 contact hour may be earned for successful completion of each activity.
Provider is approved by the California Board of Registered Nursing, Provider No. 13664, for 0.5 contact hour.
Pharmacists. The Annenberg Center for Health Sciences at Eisenhower is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. These activities have been assigned ACPE Universal Program # 0797-9999-19-094-H01-P and # 0797-9999-19-095-H01-P. Each activity is designated for up to 0.5 contact hour (0.05 CEU) of continuing pharmacy education credit. These are knowledge-based activities.
Disclosures
Commercial Support
These activities are supported by educational grants from BTG International Inc.
Relationships of Faculty and Planners
All individuals in a position to control the content of these activities (eg, planners, faculty, reviewers) must disclose all financial relationships with commercial interests that may have a bearing on its subject matter. The Annenberg Center for Health Sciences at Eisenhower has identified and resolved all conflicts of interest in accordance with its policies and procedures. Participants should assess the impact (if any) of the disclosed information on the educational value of the activity.
Faculty
Nancy Nix, PharmD, BCPS, BCOP is on the speakers bureau for Coherus Biosciences and has been on the advisory boards for Bristol-Myers Squibb, Genentech, Puma, Sandoz, and Teva.
Kristi K. Posey, PA-C, has nothing to disclose.
Haleigh Mistry, MS, PA-C, has nothing to disclose.
Planners and Reviewers
Activity reviewers and the staff of the Annenberg Center for Health Sciences at Eisenhower and Harborside Medical Education have nothing to disclose.
Product Disclosure
These activities may include discussion of agents that have not yet been approved by the U.S. Food and Drug Administration and investigational uses of approved products. Please consult prescribing information and practice guidelines for detail regarding safe and effective use of therapeutic agents.
Disclaimer
The opinions expressed in these activities are those of the faculty and do not represent an endorsement by the Annenberg Center for Health Sciences at Eisenhower of any therapeutic agent or approach to diagnosis or patient management.
Case Study 1: HDMTX-Induced AKI in Osteosarcoma
Using the case of a 31-year-old female patient undergoing treatment for osteosarcoma, Nancy Nix, PharmD, BCPS, BCOP, and Kristi Posey, PA, discuss risk factors for acute kidney injury following high-dose methotrexate (HDMTX) treatment, as well as the importance of pretreatment patient counseling and working as a team to quickly identify and treat delayed HDMTX clearance. They also take a deep dive into the consensus guidelines on the use of glucarpidase rescue and how to correlate clinical findings and lab values to increase the timeliness of treatment decision making.
Posted: September 10, 2019 / Expires: September 10, 2020
0.5 Credit
This certified activity has expired but you may watch the video without claiming credit.
Case Study 2: HDMTX-Induced AKI in CNS Lymphoma
Nancy Nix, PharmD, BCPS, BCOP, and Haleigh Mistry, MS, PA-C, discuss the case of a 58-year-old female patient receiving high-dose methotrexate (HDMTX) as part of treatment for central nervous system lymphoma. Together, they review contraindications to HDMTX; the importance of adequate hydration and urine alkalinization prior to initiating therapy; the mechanisms of action of MTX, glucarpidase, and leucovorin; as well as recent studies demonstrating improved outcomes, decreased mortality, and shorter length of hospital stay among patients receiving glucarpidase for HDMTX-induced acute kidney injury.
Posted: September 10, 2019 / Expires: September 10, 2020
0.5 Credit
This certified activity has expired but you may watch the video without claiming credit.
These activities, certified for CME/CE/CPE credit, are jointly provided by
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