Management of cytotoxic chemotherapy in patients undergoing dialysis: a still unresolved issue of onconephrology

The incidence of tumors increases significantly in individuals with chronic kidney disease (CKD), particularly among those undergoing dialysis. This dialysis-associated condition not only impacts therapy but also influences the prognosis of oncological patients, contributing to heightened mortality rates related to both cancer and non-cancer causes. Importantly, it stands as a primary factor leading to suboptimal utilization of therapies. Dosage adjustment for many types of chemotherapy is a necessity in patients with kidney impairment. However, due to a lack of comprehensive knowledge about the pharmacokinetic and pharmacodynamic properties of these drugs in dialysis, adjustments are often made empirically, and in many cases, chemotherapy is avoided altogether. In this review, we highlight the current challenges and gaps in knowledge, and emphasize the imperative need for dedicated research to establish evidence-based guidelines for chemotherapy management in this vulnerable patient population.