Cancer therapy in patients with reduced kidney function

Area of Science:

• Oncology
• Nephrology
• Pharmacology

Background:

• Chronic kidney disease (CKD) and cancer are increasing public health concerns.
• Co-occurrence of CKD and cancer is rising, complicating treatment decisions.
• Cancer therapies can cause kidney damage, especially in CKD patients with comorbidities.

Purpose of the Study:

• To review renal toxicities of various anticancer therapies.
• To provide recommendations for monitoring and managing cancer treatment in CKD patients.
• To offer dosage guidelines for select agents in advanced CKD.

Main Methods:

• Comprehensive review of renal toxicities associated with conventional chemotherapy, targeted therapy, immune checkpoint inhibitors, and radioligand therapies.
• Analysis of electrolyte disturbances and metabolic abnormalities in CKD patients undergoing cancer treatment.
• Examination of limited data on patients with kidney replacement therapy.

Main Results:

• Anticancer agents can cause significant electrolyte disturbances (e.g., hyponatremia, hyperkalemia) in CKD patients.
• Close monitoring of electrolytes, minerals, and acid-base status is crucial before and during treatment.
• Limited evidence exists for managing cancer therapies in patients on kidney replacement therapy.

Conclusions:

• Multidisciplinary team approach involving oncologists and nephrologists is essential for optimal cancer treatment in CKD patients.
• Onconephrology is a critical and expanding subspecialty for managing these complex cases.
• Effective and safe anticancer treatment is achievable for CKD patients with careful management.