Having chemotherapy when you are on dialysis

Often, yes. Being on dialysis does not automatically rule out chemotherapy, although it makes planning more complex and information for patients is scarce. When the kidneys have failed, medicines that are normally removed through urine stay in the body longer, so some chemotherapy medicines need lower amounts, some are best avoided, and others can be used much as usual because the liver clears them. Dialysis itself can remove some medicines from the blood. This means the timing of chemotherapy in relation to dialysis sessions matters: some medicines are given straight after a session so they have time to work before the next one, while for others, dialysis is scheduled at a set time after the infusion to clear the medicine safely. Your oncologist, kidney doctor and dialysis unit work out this timing together.

Examples help show the variety. Carboplatin is often used with amounts calculated for dialysis and careful timing. Cisplatin may be used in selected situations with adjustment. Some medicines, such as pemetrexed, methotrexate and capecitabine, are generally avoided in people on dialysis because they can build up to harmful levels. Many medicines processed by the liver, including some taxanes and anthracyclines, may need less adjustment. These choices are for your specialists and depend on your cancer, other conditions and the latest evidence.

Dialysis brings practical challenges too. Many people already travel for dialysis several times a week, and adding chemotherapy visits can be exhausting, so try to coordinate appointments. Low white cells raise the risk of infection at fistula or catheter sites. Low platelets increase bleeding at needle sites, and the blood thinner used during haemodialysis may need adjusting. Fluid given with chemotherapy has to fit within fluid limits. Blood counts, potassium and other salts are monitored closely.

Tell your dialysis unit your chemotherapy dates

They may need to change session times or blood thinner use.

Watch your access site

Report redness, pain, swelling or discharge at your fistula or catheter straight away.

Low red cells are common

Both kidney failure and chemotherapy lower red cells. Your team monitors this closely.

It cannot tell you which chemotherapy is safe with dialysis, or how to time it. That depends on the medicines, your type of dialysis, your cancer and other conditions, and must be decided by your specialists together.

It also cannot predict how you will cope. People on dialysis often have other health problems, and treatment plans are tailored to overall fitness as well as kidney function.

Haemodialysis and peritoneal dialysis

Most experience with chemotherapy comes from people on haemodialysis, where sessions happen at a unit. People on peritoneal dialysis, done at home through a tube in the tummy, can also have chemotherapy, but the removal of medicines is different, and infection of the tummy lining is an extra concern when white cells are low. Your team will explain how your dialysis type affects the plan.

Myeloma and kidney failure

In some cancers, especially myeloma, kidney failure is caused by the cancer itself. Treating the cancer promptly can sometimes improve kidney function enough for dialysis to stop. Your team will discuss this possibility with you.

Transplant waiting lists

A cancer diagnosis usually affects eligibility for a kidney transplant for a period. Ask your kidney doctor how your cancer and treatment affect transplant plans.

Nutrition on dialysis and chemotherapy

Dialysis diets limit potassium, phosphate, salt and fluids, while chemotherapy often reduces appetite. A renal dietitian can help balance these needs so you get enough protein and energy safely.

Tiredness and travel

Combining dialysis and chemotherapy is tiring. Ask whether appointments can be scheduled on the same day or close together, and arrange transport and support at home.

Medicines for side effects

Some anti-sickness, pain and antibiotic medicines need adjustment on dialysis. Always check with your team before taking anything new.

Red cell support on dialysis

People on dialysis often receive injections that stimulate red cell production, and iron. During chemotherapy, red cells can fall further. Your kidney doctor and oncologist decide whether to continue these injections, give blood transfusions, or adjust plans, since red cell boosting injections carry some risks in people with cancer.

Potassium, phosphate and diet during treatment

Sickness and diarrhoea during chemotherapy can change potassium levels quickly, while tumour breakdown in fast-growing cancers can raise potassium and phosphate. Both high and low potassium affect heart rhythm. Blood tests before dialysis sessions help catch changes, and your dialysis unit may adjust the dialysis fluid.

Blood pressure during dialysis

Blood pressure can drop during dialysis, especially when you are dehydrated from vomiting or eating poorly. Tell dialysis staff about chemotherapy side effects so they can adjust fluid removal.

Medicines given at the dialysis unit

Some units can give certain supportive medicines, such as injections to support blood counts, during dialysis sessions, which reduces extra hospital visits. Ask whether this is possible.

Veins, ports and future access

People on dialysis may not be able to have a port in the usual place if veins are needed for future dialysis access. Your kidney and oncology teams will agree the safest option for giving chemotherapy.

Planning for difficult weeks

Arrange transport and support for weeks when chemotherapy and dialysis overlap most, as tiredness can build.

What to do next

Ask your oncologist and kidney doctor to plan together, get a written schedule linking chemotherapy and dialysis, inform your dialysis unit, watch your access site, stick to fluid limits, check with the team before any new medicine, and seek urgent help for fever or bleeding.