ISN East & Central Europe Regional Board Webinar: Onconephrology – a challenge for both specialities

Cancer is a major public health issue worldwide and the second leading cause of death in the United States and Europe. The prevalence of chronic kidney disease (CKD) is high in cancer patients, with an estimated 50% of patients with solid neoplasms having an eGFR <90 ml/min/1.73m^2 (stage 2 CKD or higher), and 10-20% having an eGFR <60 ml/min/1.73m^2 (stage 3 or 4 CKD). Additionally, acute kidney injury (AKI) frequently occurs during cancer treatment, affecting 17.5% of patients in the first year of diagnosis and 27% by the fifth year. A significant number of these patients will develop CKD, as shown by a large cross-sectional study of 4,925 cancer patients reporting a deterioration of eGFR by 13 ml/min/1.73m^2 and worsening of CKD category from stage 2 to stage 3 or 4 in 17.7% of patients during a 2-year follow-up.

The combination of cancer and CKD, particularly advanced CKD such as stage 5/5D, is predictive of early mortality. Kidney dysfunction affects the elimination and metabolism of anti-cancer drugs, leading to suboptimal therapy in CKD 5/5D patients, and many are excluded from clinical trials. Moreover, CKD stage 5 patients are at risk of therapeutic drug removal during kidney replacement therapy (KRT), potentially leading to a loss of anti-tumor efficacy. Understanding potential pharmacokinetic/pharmacodynamic modifications before prescribing anticancer drugs to this patient population could improve their utilization, although the effects of advanced CKD on the pharmacokinetics and pharmacodynamics of many drugs remain unknown. There is a clear need to study anticancer drugs in CKD stage 5, especially considering the growing population in this category.

Learning objectives: 

- Understand the emergence of onconephrology as a new specialty.
- Recognize the challenges faced by patients with CKD in accessing therapy.
- Explore the feasibility of oncology therapy for patients with advanced CKD, including those undergoing KRT.

Further reading:

- Kitchlu A, Reid J, Jeyakumar N, Dixon SN, Munoz AM, Silver SA, Booth CM, Chan CTM, Garg AX, Amir E, Kim SJ, Wald R. Cancer Risk and Mortality in Patients With Kidney Disease: A Population-Based Cohort Study. Am J Kidney Dis. 2022 Oct;80(4):436-448.
- Serkies K, D1rbska-Slizien A, Kowalczyk A, Lizakowski S, Matyszko J. Malignancies in adult kidney transplant candidates and recipients: current status. Nephrol Dial Transplant. 2023.
- KDIGO Controversy Conference on Onconephrology