Introduction

Dialysis is a treatment that helps remove waste and extra fluid from the body when the kidneys aren’t working properly. Normally, our kidneys do this job, but if they become injured or overwhelmed, dialysis acts as a support system.

There are two main types of dialysis: haemodialysis, which filters your blood through a machine, and peritoneal dialysis, which uses the lining of your abdomen to clean your blood.

Tumour lysis syndrome (TLS) is a rare but serious condition that can happen when cancer cells break down quickly, either on their own or after treatment. This sudden breakdown releases substances into the blood that can overwhelm the kidneys and cause dangerous changes in body chemistry.

The symptoms include: Nausea, vomiting, diarrhoea, muscle cramps or twitches, weakness, numbness or tingling, fatigue, decreased urination, irregular heart rate, confusion, restlessness, irritability, delirium, hallucinations, and convulsions.TLS is diagnosed using blood tests and signs of kidney stress after starting cancer treatment.⁴ 

Mechanism of acute kidney injury in tumour lysis syndrome and treatment

When cancer cells break down quickly, they release substances like potassium, uric acid, and phosphate into the bloodstream. If these build up too fast, they can damage the kidneys and lead to acute kidney injury (AKI).

The treatment focuses on protecting the kidneys and keeping the body in balance. This includes:

• Drinking plenty of fluids through a drip (IV hydration)
• Medicines like allopurinol or rasburicase are used to lower uric acid
• Medications to move potassium back into cells and protect the heart
• Phosphate binders to control phosphate levels

Sometimes, low calcium levels do not need to be treated unless they cause symptoms.⁶

Indications for dialysis (renal replacement therapy)

In severe cases, with a lack of responsiveness to conservative methods of management, renal replacement therapy may be required. The necessity for renal replacement therapy has decreased significantly in recent years, due to the development and use of hyperuricemia drugs, but it is indicated in the following conditions ^7:Dialysis may be needed if the body is no longer responding to other treatments. You might need dialysis if you have:

• Severe kidney failure
• High potassium or phosphate levels that won’t go down
• Fluid overload (too much fluid in the body)
• Symptoms of low calcium
• Very high levels of uric acid

Haemodialysis is usually preferred over peritoneal dialysis because it clears waste more quickly. In some cases, a type of continuous dialysis (called continuous venovenous filtration) is used, especially in critically ill patients.

Outcomes of dialysis in tumour lysis syndrome

Dialysis can help correct the chemical imbalances caused by TLS within hours. In many cases, improvements are seen in 6–12 hours. Dialysis continues until your kidneys recover enough to work on their own again.

Challenges and considerations

Patients who need dialysis due to TLS may spend longer in the hospital and have higher treatment costs. They may also have a lower chance of recovering fully from cancer.

That’s why it’s so important to identify people at risk before starting chemotherapy. Dialysis should be available on-site, and kidney specialists should be involved early if there are any signs of trouble.

Prevention of tumour lysis syndrome

The best way to manage TLS is to prevent it. This includes:

• Identifying people at risk before cancer treatment
• Starting hydration early
• Using medicines like allopurinol or rasburicase
• Watching for early signs like nausea, tiredness, and low urine output

Talk to your doctor if you’re about to start chemotherapy for a fast-growing cancer. You may need special care to reduce your risk of TLS.¹²

Conclusion and Summary

TLS is a serious complication, but with early care and monitoring, it can be managed well. Dialysis is a powerful tool that can reverse the effects of TLS, especially when kidney function declines.

Still, prevention is key. Recognising high-risk patients and acting early can make all the difference, both in saving lives and reducing complications.

If you or a loved one is receiving cancer treatment, ask your healthcare team about your risk of TLS and what steps are in place to manage it.