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NDT Advance Access originally published online on April 19, 2005
Nephrology Dialysis Transplantation 2005 20(6):1187-1191; doi:10.1093/ndt/gfh807
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org

Original Article

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

Benjamin Boesler1, David Czock1, Frieder Keller1, Martin Griesshammer2, Thomas Seufferlein3, Wolfram Karges3 and Franz Maximilian Rasche1

1 Division of Nephrology, 2 Department of Haematology and Oncology, and 3 Department of Gastroenterlogy, University Hospital Ulm, Germany

Correspondence and offprint requests to: Frieder Keller, MD, Nephrology, Medical Faculty, University of Ulm, Robert-Koch-Strasse 8, D-89070 Ulm, Germany. Email: frieder.keller{at}medizin.uni-ulm.de

Background. Chemotherapy is not given routinely to patients with malignancies receiving chronic haemodialysis because evidence of a clear benefit is still lacking and severe side effects are feared. The aim of our retrospective study was to analyse the methods of dose adjustment and the clinical course of chronic haemodialysis patients with malignancies treated by chemotherapy.

Methods. Between 1985 and 2001, a total of 48 cycles of 21 chemotherapy protocols were administered to 16 dialysis patients with nine haemoblastic and seven solid malignancies. We compared the dose actually administered with that theoretically derived from the proportional dose reduction rule of Dettli and the rule of Giusti and Hayton, using published pharmacokinetic parameters.

Results. Kaplan–Meier estimates of median survival time were 30 months in patients with haemoblastic malignancies and 10 months for patients with solid malignancies. Eleven chemotherapies were administered in standard dosages and 10 chemotherapies in reduced dosages (39–80% of the regular dose); in all therapies, however, the dose was significantly higher than proposed by the Dettli rule (P<0.01).

Conclusion. 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.

Keywords: chemotherapy; dose adjustment; haemodialysis; malignancies; nephropharmacology; pharmacokinetics


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