[Malignancies in patients on dialysis]

Area of Science:

• Nephrology
• Oncology
• Internal Medicine

Context:

• Patients undergoing dialysis exhibit a higher prevalence of malignancies compared to the general population.
• Malignancies can either cause kidney failure necessitating dialysis or arise as a consequence of dialysis treatment and its associated factors.
• The complex interplay between renal failure, dialysis, and cancer risk necessitates a comprehensive understanding for improved patient care.

Purpose:

• To comprehensively review the multifaceted relationship between malignancies and dialysis.
• To explore the etiological factors, diagnostic challenges, treatment implications, and ethical considerations surrounding cancer in dialysis patients.
• To highlight the increased risk of specific cancers, such as renal, urinary tract, pharyngeal, laryngeal, and thyroid malignancies, in this population.

Summary:

• Malignancies can lead to renal failure requiring dialysis, or conversely, dialysis patients face increased cancer risks due to factors like underlying diseases, metabolic changes, compromised immunity, and dialysis-related exposures.
• Diagnostic difficulties, including the uncertain utility of tumor markers, are discussed, alongside the predominant causes of death (cardiovascular and infectious diseases) in dialyzed patients.
• Renal replacement therapies can be integrated into cancer treatment (e.g., tumor lysis syndrome management), and ethical dilemmas, such as dialysis withdrawal, are addressed.

Impact:

• This review provides critical insights for clinicians managing dialysis patients, emphasizing the need for proactive cancer screening and risk assessment.
• Understanding the unique oncological challenges in dialysis patients can lead to more tailored diagnostic and therapeutic strategies.
• Addressing the ethical considerations is crucial for providing humane and patient-centered care at the end of life.