Understanding Dialysis and Kidney Cancer
Dialysis is a life-saving medical treatment for individuals with kidney failure, a condition where the kidneys are no longer able to adequately filter waste products from the blood. There are two main types of dialysis, which includes hemodialysis, which uses a machine to clean the blood, and peritoneal dialysis, which uses the lining of the abdomen to filter blood inside the body. For patients with chronic kidney disease (CKD), especially those in the advanced stages, dialysis is necessary to perform the functions normally carried out by healthy kidneys. At the same time, long-term dialysis can lead to several changes in the kidney tissue, which may increase the risk of developing kidney cancer.
Link Between Dialysis and Kidney Cancer
Studies suggest that the longer a patient is on dialysis, the greater their risk of developing renal cell carcinoma (RCC), the most common type of kidney cancer. This increased risk is believed to be linked to the chronic inflammatory state and the accumulation of toxins that occurs in end-stage renal disease. This can lead to DNA damage and cellular changes, which predispose individuals to cancer. Additionally, cysts often develop in failing kidneys over time, and these cysts have a higher likelihood of becoming cancerous. In some cases, the kidneys develop cysts as a result of compensatory hyperplasia, a process where the kidney cells multiply in an attempt to enhance the remaining kidney function. Over time, these cysts can become numerous and increase in size, creating a condition known as acquired cystic kidney disease (ACKD). ACKD is common in individuals who have been on dialysis for several years and is a known risk factor for the development of kidney cancer.
Symptoms and Diagnosis of Kidney Cancer in Dialysis Patients
Symptoms
In dialysis patients, the symptoms of kidney cancer may be masked by the underlying chronic kidney disease. Symptoms such as fatigue, weight loss, and changes in urine output are frequently attributed to kidney failure rather than cancer. Certain signs may indicate kidney cancer, including blood in the urine (hematuria), a palpable mass in the abdomen, and persistent pain in the side or back.
Diagnosis
Ultrasound can help in identifying the presence of solid masses or complex cysts, which may indicate cancer. Non-contrast MRI provides detailed images of the kidney’s structure and can detect smaller tumours that might not be visible on ultrasound. If these imaging studies suggest the presence of a renal tumour, a biopsy can be performed to confirm the diagnosis. Regular screening and monitoring for kidney cancer should be conducted for long-term dialysis patients, especially those with acquired cystic kidney disease. This allows for the early detection of cancer, improving treatment outcomes and survival rates.
Treatment Options for Kidney Cancer in Dialysis Patients
The mainstay of treatment for localised kidney cancer is surgery, but the approach may differ depending on each individual’s condition, taking into account the stage of cancer, the patient’s overall health, and the presence of other medical issues.
Surgical Treatment
The most common surgical procedure is nephrectomy, which involves the removal of the affected kidney. In dialysis patients, a radical nephrectomy, removing the entire kidney, is often preferred due to the existing kidney function impairment. Partial nephrectomy, where only the tumour and a small margin of healthy tissue are removed, may be considered in certain cases, especially if the patient is a candidate for a future kidney transplant.
Non-Surgical Treatments
For patients who are not suitable candidates for surgery due to either the extent of cancer or other health considerations, alternative treatments may be considered. These include ablative therapies like cryoablation or radiofrequency ablation, which destroy cancer cells by freezing or heating them, respectively.
Targeted Therapy and Immunotherapy
These therapies are often used in advanced or metastatic kidney cancer. Targeted therapies work by blocking specific pathways that cancer cells use to grow and spread. Immunotherapy boosts the body’s immune system to fight cancer.
Supportive Care
This includes managing symptoms and improving the quality of life for patients with advanced kidney cancer. Palliative care may involve pain management, nutritional support, and psychological counselling.
Managing Dialysis with Kidney Cancer
For patients diagnosed with kidney cancer who are already on dialysis, managing their condition becomes a delicate balance between treating cancer and continuing dialysis treatment. This requires a comprehensive and coordinated approach to ensure both the efficacy of cancer treatment and the maintenance of optimal dialysis care.
Adjustments to Dialysis Regimen
Depending on the type of cancer treatment, adjustments to the dialysis regimen may be necessary. For instance, if a patient undergoes surgery, dialysis schedules might be modified to accommodate post-operative recovery. Similarly, dialysis sessions may need to be tailored around chemotherapy or radiation therapy sessions in patients receiving these treatments.
Monitoring for Complications
Patients undergoing treatment for kidney cancer while on dialysis need close monitoring for potential complications. This includes monitoring for signs of infection, changes in blood pressure, and electrolyte imbalances, which can be more common in these patients.
Nutritional Management
Adequate nutrition plays a role in supporting patients through cancer treatment and dialysis. Dietitians may work with patients to ensure they receive the necessary nutrients, especially as appetite and dietary restrictions can be affected by both dialysis and cancer treatments.
Psychosocial Support
The dual diagnosis of kidney cancer and the need for ongoing dialysis can be overwhelming. Providing access to psychological support, such as counselling or support groups, can help patients cope with their condition and treatment.
Pain Management
Effective pain management is necessary, as cancer and post-surgical recovery can cause discomfort. Pain management should be carefully coordinated with the dialysis treatment to avoid any adverse effects on kidney function.
Conclusion
Understanding the increased risk of kidney cancer in long-term dialysis patients, recognising the symptoms to ensure a timely diagnosis, and choosing the appropriate treatment strategies can help manage the condition. Treatment of kidney cancer in dialysis patients requires a tailored approach, considering the individual’s overall health, the stage of cancer, and the specific needs related to dialysis.
