Role of renal replacement therapy in Tumor lysis syndrome
What is the role of renal replacement therapy in the treatment and/or prevention of TLS?
In general, indications for dialysis in patients with AKI secondary to TLS are similar to indications for dialysis in AKI from other causes. Indications include life-threatening hyperkalemia, volume overload refractory to diuretics, uremic pericarditis, or severe uremic encephalopathy. Dialysis has the added benefit of being able to clear uric acid and phosphorus, which may help prevent further kidney damage. If rasburicase is not available, early hemodialysis for uric acid clearance should be considered and has been shown to increase urine output in oliguric AKI. Clearance rates of uric acid with hemodialysis (70 to 145 mL/min) are much greater than with peritoneal dialysis (6 to 10 mL/min), making it the renal replacement therapy of choice.
