Optimizing Oncological Care in Patients with End-Stage Chronic Kidney Disease on Dialysis: Indian Scenario

Background In India, around 55,000 patients are on dialysis, with a 10–20% annual increase. With the growing dialysis population in India, cancer risk among end-stage renal disease (ESRD) patients is increasing. Managing chemotherapy in these patients is challenging due to limited data and guidelines, leading to treatment uncertainty.

Objectives This study provides real-world data from India on the clinical management and outcomes of cancer patients with ESRD undergoing dialysis while receiving chemotherapy.

Material and Methods This prospective study analyzed data from five cancer patients with end-stage renal disease (ESRD) on hemodialysis prior to diagnosis of cancer treated at a tertiary oncology center in India. We analyzed the demographic details, cancer staging, treatment regimens, and dosage adjustments. Treatment modifications due to renal dysfunction, toxicities, and patient outcomes were also reviewed over a 12-month follow-up.

Results The cohort consisted of 80% (4/5 pts) females, with a median age of 57.8 years. Hypertensive and diabetic nephropathy were the leading causes of ESRD. Cancers included breast (3/5 pts), lung (1/5 pts), and ovarian (1/5 pts), with varying stages of diagnosis. 80% (4/5) of patients required tailored drug management. The Ovarian cancer patient experienced severe hypersensitivity to carboplatin, which was managed conservatively. No grade 3/4 immune-related adverse events occurred, and all patients were alive and disease-free at the one-year follow-up.

Conclusion Carefully tailored treatment strategies and a coordinated multidisciplinary approach allowed positive outcomes for cancer patients on dialysis, emphasizing the need for personalized approaches. These findings highlight the importance of refining treatment protocols for this complex group.