Clinical course of haemodialysis patients with malignancies and dose-adjusted chemotherapy

Boesler, Benjamin; Czock, David; Keller, Frieder; Grießhammer, Martin; Seufferlein, Thomas; Karges, Wölfram; Rasche, Franz Maximilian

doi:10.1093/ndt/gfh807

Cited by 17 publications

(13 citation statements)

References 15 publications

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“…The contradiction in findings between these studies could be due to the small number of patients and lack of adjustment for several confounders that interfere with patient survival. Furthermore, there is evidence suggesting that MM patients on dialysis are variably undertreated and they do not receive all optimal chemotherapy for the fear of side effects, and usually they are not considered and they do not benefit from ASCT [10,16,17,20]. The ERA-EDTA Registry did not collect histological data, clinical or biochemical information and therefore cannot present results on the association between such possible prognostic factors and the clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and outcome of patients starting renal replacement therapy for end-stage renal disease due to multiple myeloma or light-chain deposit disease: an ERA-EDTA Registry study

Tsakiris

Stel

Finne

et al. 2009

Nephrology Dialysis Transplantation

116

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Background. Information on demographics and survival of patients starting renal replacement therapy (RRT) for endstage renal disease (ESRD) due to multiple myeloma (MM) or light-chain deposit disease (LCDD) is scarce. The aim of this study was to describe the incidence, characteristics, causes of death and survival rates of RRT for ESRD due to MM or LCDD in the ERA-EDTA Registry. Methods. Thirteen national registries providing data on patients who started RRT from 1986-2005 to the ERA-EDTA Registry participated. Incidence per million population (pmp) of RRT for ESRD due to MM or LCDD and other causes (non-MM) was observed overtime. Patient survival on RRT was examined, unadjusted and adjusted for age and gender. Results. Of the 159 637 patients on RRT, 2453 (1.54%) had MM or LCDD. The incidence of RRT for ESRD due to MM or LCDD, adjusted for age and gender, increased from 0.70 pmp in 1986-1990 to 2.52 pmp in 2001-2005. MM and LCDD patients compared to non-MM patients were older and a higher percentage was on haemodialysis at day 91 after the start of RRT. The most common causes of death in MM and LCDD patients were malignancy (36.1%), cardiovascular causes (17.2%) and infection (14.7%). MM and LCDD patients had a 2.77 (95% CI, 2.65-2.90) higher risk of death compared to non-MM patients. The unadjusted median survival on RRT was 0.91 years in MM and LCDD patients and 4.46 years in non-MM patients. During follow-up, 35 patients were transplanted and their mean survival was 9.6 years. Conclusion. The incidence of RRT for ESRD due to MM or LCDD has increased over the past 20 years in Europe. The median patient survival on RRT for MM and LCDD patients was 0.91 years, compared to 4.46 years for non-MM patients. These results suggest that dialysis, and in selected cases even transplantation, should be offered to MM and LCDD patients.

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Section: Discussionmentioning

confidence: 99%

“…In the literature, there are several smaller studies comparing outcome of patients with MM with renal insufficiency dependent on dialysis or not [14,16,[18][19][20]23]. In these reports, median survival on dialysis ranged from 2 months to 47 months, and this wide variation contains contradictory findings.…”

Section: Discussionmentioning

confidence: 99%

Incidence and outcome of patients starting renal replacement therapy for end-stage renal disease due to multiple myeloma or light-chain deposit disease: an ERA-EDTA Registry study

Tsakiris

Stel

Finne

et al. 2009

Nephrology Dialysis Transplantation

116

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“…A pharmacokinetic modeling study of chemotherapeutic agents used in patients with cancer undergoing dialysis suggested that these agents are generally overdosed. 30 Overdosing can aggravate systemic toxicities, with fatal consequences, whereas underdosing can lead to ineffective cancer treatment. Thus, because the CKD-ESRD population has a higher prevalence of cancer and the CKD-ESRD population is increasing, more precise dosing recommendations for this population are needed.…”

Section: Unique Features Of Nephrologic Disorders In Cancermentioning

confidence: 99%

Onconephrology

Salahudeen

Bonventre

2013

Journal of the American Society of Nephrology

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Renal diseases in patients with cancer have many unique features, and often these diseases require specialized approaches. Newer cancer therapy has increased cancer cure rate and survival time, but such benefit is not fully realized, partly because of therapy-associated toxicities. Fluid and electrolyte abnormalities are very common in patients with cancer, as are acute and chronic kidney injury. With the evolving complexities of newer cancer therapies, a comprehensive team approach is becoming necessary. It is essential for nephrologists to be informed and involved in cancer care. Many nephrologists caring for patients with cancer in the United States have recently met and formed a focus group, the OncoNephrology Forum, under the American Society of Nephrology. This update addresses what is clinically unique about onconephrology, the objectives and functions of the newly formed forum, and the potential of onconephrology becoming a subspecialty in nephrology.

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“…There are many cytostatic drugs that are not dependent on kidney function. Cytostatic agents that are [ 10 ]. For dialysis patients the effect of dialysis has to be taken into account additionally.…”

Section: Hit Hard and Early In Infections And Tumor Therapymentioning

confidence: 99%

Drug Prescription in Chronic Kidney Disease

Kielstein

2014

Management of Chronic Kidney Disease

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Clinical course of haemodialysis patients with malignancies and dose-adjusted chemotherapy

Abstract: Chemotherapy in patients with haemodialysis is feasible. Individual dose adjustment should be performed on the basis of pharmacokinetic data and the general condition of the patient, but it is still a matter of expert judgement, as there is no formal evidence available.

Cited by 17 publications

References 15 publications

Incidence and outcome of patients starting renal replacement therapy for end-stage renal disease due to multiple myeloma or light-chain deposit disease: an ERA-EDTA Registry study

Incidence and outcome of patients starting renal replacement therapy for end-stage renal disease due to multiple myeloma or light-chain deposit disease: an ERA-EDTA Registry study

Onconephrology

Drug Prescription in Chronic Kidney Disease

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