Glucarpidase treatment significantly improves kidney recovery in methotrexate-associated AKI patients, with a 2.7-fold increase in recovery odds, faster recovery time, and reduced risks of neutropenia and transaminitis. Benefits were more pronounced in females and stage 3 AKI patients. The study, involving 708 patients from 28 centers, highlights glucarpidase's potential beyond methotrexate level reduction, despite its high cost and varied hospital usage.