Chemotherapy and dialysis

Hi everyone. I am currently undergoing chemotherapy for a metastatic bladder cancer recurrence. It has been 5 years since the first metastatic occurance and I had a kidney during the chemo then. This time, I am having serious setbacks with dangerously low platelets that aren’t responding to transfusions and seriously low white cell counts. I know administering chemo without kidneys and while on dialysis is an art/science in itself and I would imagine timing of administration and dialysis as well as dosing alterations are important.

Can anyone point me in the direction of some research or professionals who are knowlegeable about chemotherapy administration and dialysis? This is a critical link to my treatment that is currently missing.


Hi Wendy,
I’m not sure where you live, and unless what you’re looking for is email or phone consultation, it might be handy to have someone who is nearby. If you have no kidneys, you are anephric. So, I did a search in PubMed (published medical literature–anyone can search it) for “anephric chemotherapy.”

I did find a paper (from 5 years ago) by 5 California MDs about giving a certain type of chemo to someone with ESRD for renal cell (not bladder) cancer. In case their names might be handy, here is the abstract:

BJU Int. 2006 Feb;97(2):279-80.
High-dose interleukin-2 immunotherapy is safe for patients with metastatic renal cell carcinoma on dialysis.
Brusky JP, Gailani F, Pathak A, Patel H, Aboseif S.
Urology, Kaiser Permanente, Los Angeles, CA, USA.
To report our experience of high-dose interleukin-2 immunotherapy for patients with metastatic renal cell carcinoma (RCC) on haemodialysis.
Two anephric patients with metastatic RCC on haemodialysis received interleukin-2 (600,000 IU/kg) every 8 h for a maximum of 14 doses. The patients rested for 9 days and cycles were repeated as tolerated. A nephrologist followed the patients during treatment and they received nearly daily haemodialysis.
These two cases were treated with high-dose interleukin-2 and had no unusual toxicity or adverse events. The first patient tolerated five, five, four, four and one dose of interleukin-2 over five cycles. He had a partial response to treatment with a decrease in size of a mediastinal mass, but ultimately developed progressive disease and died 32 months later. The second patient had four cycles of interleukin-2 (13, 13, 14 and nine doses). He initially maintained stable disease throughout treatment, but the disease ultimately progressed and he died 19 months later.
We recommend considering high-dose interleukin-2 immunotherapy in highly selected dialysis patients with metastatic RCC. Further study is required to determine the safety, efficacy and optimum dosing in this group.

That said, I wonder, since your bladder has cancer, whether surgery might be a (non-chemo) option? And, another suggestion might be to see how closely your nephrologist would be willing to cooperate with your oncologist. With both on board, you might not need to seek out a distant expert to get the care you need. Please let us know how it goes for you.

Thank you Dori. I will contact the author(s) to see if they have any suggestions. The metastatic recurrence is in a lymph node behind my esophogas. Can’t do surgery - but can do radiation which I will most likely decide for on Wednesday. I had my bladder removed 7 years ago and both kidneys removed 2 and 4 years after that. Chemo is important to treat systemically because the odds of other metastatic cells lurking around are high.

I appreciate your help. Thank you.

Let us know how it goes, Wendy, and if there is anything else I can help research for you.