Cancer Drug Dosing in Chronic Kidney Disease and Dialysis

Adv Chronic Kidney Dis. 2022 Mar;29(2):208-216.e1. doi: 10.1053/j.ackd.2021.12.002.

Abstract

Patients with malignancies have a high prevalence of kidney disease and are often treated with antineoplastic agents that undergo kidney metabolism or excretion or clearance via renal replacement therapies. Thus, the dosing of these agents, including classic chemotherapeutic drugs, targeted therapies, and immunotherapy, must take into account patients' kidney function. In this review, we will discuss the pitfalls of accurate measurement of kidney function and how kidney disease affects both pharmacodynamic and pharmacokinetic properties of drugs. Lastly, we will discuss specific agents and summarize current dosing strategies for use in patients with chronic kidney disease and end-stage kidney disease.

Keywords: Chemotherapy; Chronic kidney disease; Glomerular filtration rate; Kidney function measurement; Renal replacement therapy.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antineoplastic Agents* / therapeutic use
  • Glomerular Filtration Rate
  • Humans
  • Kidney
  • Neoplasms* / complications
  • Neoplasms* / drug therapy
  • Renal Dialysis
  • Renal Insufficiency, Chronic* / complications
  • Renal Insufficiency, Chronic* / metabolism
  • Renal Insufficiency, Chronic* / therapy
  • Renal Replacement Therapy

Substances

  • Antineoplastic Agents