Cancer screening and treatment in patients with end-stage renal disease: Remaining issues in the field of onco-nephrology

Abstract

Onco-nephrology is a rapidly growing field that has recently garnered significant attention. Although the risk of developing cancer is reported to be higher in patients with end-stage renal disease (ESRD) than in the general population, the screening protocol and the treatment of cancer in ESRD patients have not yet been established. Recent studies have suggested that cancer screening in dialysis patients would be ineffective from a cost and survival benefit perspective. Nevertheless, the ESRD population is heterogeneous, including patients of varying age and comorbidity, and it is essential to identify those who would benefit from cancer screening. Once patients with ESRD are diagnosed with cancer, anti-cancer treatment should be initiated. However, a treatment strategy has not yet been established. Although many drugs require dose adjustments in hemodialysis patients, data on the pharmacokinetics of anti-cancer agents in these patients remain scarce. This review addresses the recent evidence of cancer risk and screening in the ESRD population and the pharmacokinetics of anti-cancer agents in hemodialysis patients.