I-131 Use in Patients With Kidney Failure Receiving Dialsyis: Therapeutic Challenges and Evidence From Literature

Radioactive iodine (¹³¹I) therapy is widely used in the treatment of differentiated thyroid cancer and hyperthyroidism. However, its use in patients with kidney failure treated with hemodialysis presents unique challenges due to impaired renal clearance, prolonged systemic retention, and logistical barriers to safe delivery. In this multicenter retrospective case series, we identified 5 patients with kidney failure on maintenance hemodialysis who received ¹³¹I therapy. We discuss in this paper our experience, modified dosing, and carefully timed dialysis that were used to optimize safety and efficacy. All patients tolerated therapy without hematologic toxicity or radiation-related complications. Underlying thyroid disease was adequately addressed, and no secondary malignancies were observed during follow-up. We also described a comprehensive literature review of similar cases and revealed significant variation in dosing strategies and dialysis timing but emphasized the importance of interdisciplinary coordination and adherence to radiation safety principles. Our findings support the feasibility and short-term safety of ¹³¹I therapy in select dialysis-dependent patients when individualized dosing and dialysis planning are implemented. Further prospective studies are needed to develop standardized protocols and refine timing strategies to optimize outcomes in this high-risk population.