Pirovano Marta, Ganini Carlo, Gallieni Maurizio, Porta Camillo, Cosmai Laura
Onconephrology Outpatients Clinic, Division of Nephrology and Dialysis, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, Piazzale Principessa Clotilde 3, 20121, Milan, Italy.
Dana-Farber Cancer Institute, Boston, MA, USA.
J Nephrol. 2024 Oct 15. doi: 10.1007/s40620-024-02102-7.
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.
慢性肾脏病（CKD）患者的肿瘤发病率显著增加，尤其是在接受透析的患者中。这种与透析相关的情况不仅影响治疗，还会影响肿瘤患者的预后，导致癌症和非癌症原因的死亡率升高。重要的是，它是导致治疗利用不充分的主要因素。对于许多类型的化疗，肾功能损害患者需要调整剂量。然而，由于缺乏对这些药物在透析中的药代动力学和药效学特性的全面了解，调整往往是凭经验进行的，而且在许多情况下，完全避免进行化疗。在本综述中，我们强调了当前的挑战和知识空白，并强调迫切需要进行专门研究，以建立针对这一脆弱患者群体化疗管理的循证指南。
