Do all kidney cancer patients have dialysis?
Absolutely not. A lot of people with kidney cancer have one or one-and-a-half kidneys because they had an entire kidney removed (total nephrectomy) or part of a kidney (partial nephrectomy). Most people do fine with just one kidney. Dialysis is not something we talk about right away with kidney cancer.
What exactly is kidney dialysis?
Dialysis, also called hemodialysis, is a process in which a machine filters waste products from your blood. It is not a treatment for kidney cancer; it’s a treatment for kidney failure—when the kidneys are no longer able to clean the blood; keep safe levels of chemicals like potassium and sodium in your body; help control blood pressure; and remove waste, salt, and water.
Under what circumstances would someone with kidney cancer need dialysis?
If you have both kidneys removed, then you’d need dialysis. This could also happen if you have one kidney removed and the other one fails, or you have one kidney removed and the cancer comes back in the other kidney.
Do kidney cancer drugs increase the likelihood you’ll need dialysis?
Some of the newer medications for treating kidney cancer—such as checkpoint inhibitors, which are immunotherapy drugs, and VEGF (vascular endothelial growth factor) inhibitors, which are a type of targeted therapy—can harm your kidney function.
Checkpoint inhibitors stimulate the immune system to attack the cancer, but on occasion the immune system also attacks organs, including the kidneys. VEGF inhibitors can irritate the lining of the kidneys’ blood vessels.
Sometimes, if you stop taking those medications, kidney function will level off. But in rare instances, dialysis might be needed.
These are tough cases because these medications can be effective cancer treatments but they’re relatively new, so we’re just learning how to handle these situations.
What are the pros and cons of dialysis for someone with kidney cancer, even in the situations you mentioned?
There are several, especially on the con side. If you have metastatic kidney cancer and cancer treatments aren’t working, you may get sick or weaker after starting dialysis. If your kidney cancer was removed but you develop kidney failure, you may do just fine on dialysis. With every patient, we weigh the benefits and risks of dialysis—but the pros and cons are very patient-specific.
Can having dialysis for kidney failure raise your risk of developing kidney cancer?
Some studies have suggested that people on long-term dialysis for kidney failure, which is caused mainly by diabetes and high blood pressure, may be at increased risk for kidney cancer.
But it’s not dialysis that raises the risk: It occurs because the kidneys have gone so long without working. Why cancer risk increases as a result isn’t clear, but it shouldn’t affect the decision of whether or not to use dialysis.