What if I’m a cancer patient and I also need dialysis?

Renal failure is a recurrent condition in more than thirty percent of cancer patients during the course of their disease. The reasons for this are diverse, but they may be derived from tumor activity, as long as the kidney is involved because of a myeloma and the subsequent obstruction of the urinary tract. This is an unfortunate situation that causes tremendous pain to patients, and sometimes it’s hard to prevent, due to the silent appearance of tumors.


Image courtesy of samantha celera at Flickr.com

Renal failure is a serious complication. It impairs the quality of life and the overall prognosis of cancer patients. It is a well-known fact that the presence of renal failure implies an increased risk of dying, especially in the population of patients over 60 years, as well as when there is a cardiovascular comorbidity. The presence of these two diseases is never good news. The statistics do not yield positive data. Patients with cancer who simultaneously suffer from acute renal failure have a mortality between twenty-three and ninety-three percent. The main death reasons are related to severe hemodynamic compromise, the presence of respiratory disorders (particularly infectious, hepatic dysfunction and exposure to nephrotoxic drugs), but it does not mean that it’s a lost cause every time. Dialysis can extend the patient’s life, even if he or she suffers from an advanced stage cancer. Each organism is different, as each case is.

Many doctors believe that hemodialysis should be used in any patient with cancer and renal failure. The above, as long as the patient has a possibly treatable neoplasm. In general, if the patient has a good health and agrees with the intervention, there is basically no obstacle whatsoever that prevents the use of hemodialysis to treat his renal failure. Of course, the use of renal replacement therapy in subjects with progressing neoplasms who are not potentially curable, or when prostration greater than two months is found, is a matter of caution and the general consideration of the experts is that it is not advisable.

Related: How to choose the right treatment in case of renal failure?, by Joe Cosgrove

As a matter of fact, neoplasia is a delicate matter when it comes to dialysis. The conduct to be followed with patients undergoing periodic dialysis, which in turn develops a neoplasm, depends fundamentally on the characteristics of it. When it comes to rapidly course cancers and a tendency for metastatic spread, any type of treatment based on the tumor will be ineffective. It is important to take into account, on the other hand, the difficult management of chemotherapeutic agents in renal failure. The dialysis treatment should probably be maintained while the patient is conscious.

One thing is clear: if the patient has focused tumors with a less histological aggressiveness, and that, in turn, offer a good response to the base treatment, the reality is quite different. In these fortunate cases, patients can be maintained on dialysis, and if they do not show any evidence of activity, patients can even be considered candidates for kidney transplantation, which would simply be unthinkable in the case of a Metastasis or rapidly growing tumors.

One thing that many doctors should be aware of is the fact that individuals with a prior history of cancer do not have to be rejected categorically from the transplant program. I say this because in many cases it is given for granted that it is definitely a loss of energy, time and available organs to perform a kidney transplant for cancer patients who suffer from kidney failure and that – even – should not be treated by hemodialysis.

While it is true that immunosuppressive treatment may eventually lead to the potential risk of promoting the growth of residual tumor cells, it is not possible to make accurate predictions about the evolution of each patient. I insist: every situation is different. In fact, in many cases, an incredible evolution has been seen after transplantation in renal or ureteral cancer patients, for example. By this, I do not mean that the transplant should be performed as soon as possible because there are factors that must be evaluated beforehand and in sufficient detail (the behavior of the cancer cells in the affected tissues, mainly).


Image courtesy of Sadasiv Swain at Flickr.com

In short, it is clear that there are factors that predispose dialysis patients to the appearance of a neoplasm; especially the worsening of the immunological capacity of the uremic patient, since these patients usually suffer a severe immunosuppression (in addition to the fact that the onset of hemodialysis does not generally improve the immunosuppressive state of these patients.) It is also true that thousands of specialists suggest that dialysis itself may represent a carcinogenic risk factor since patients undergoing dialysis for a long time are exposed to large amounts of dialysis fluid that may contain carcinogenic components (nitrites, for example, may turn into nitrosamines.)

But these hypotheses have not been proven. Dialysis, like transplants, should not be ruled out. It is important to evaluate all the options (and there are many successful cases that demonstrate this).

Recommended: Association of Dialysis with the Risks of Cancers