Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Chemotherapy-related nephrotoxicity and dose modification in patients with renal insufficiency

Jaime R Merchan, MD, MMSc
Section Editor
Reed E Drews, MD
Deputy Editor
Diane MF Savarese, MD


A variety of renal disease and electrolyte disorders can result from the drugs that are used to treat malignant disease. Chemotherapeutic agents can affect the glomerulus, tubules, interstitium, or the renal microvasculature, with clinical manifestations that range from an asymptomatic elevation of serum creatinine to acute renal failure requiring dialysis.

The kidneys are a major elimination pathway for many antineoplastic drugs and their metabolites. Renal impairment can result in delayed drug excretion and metabolism of chemotherapeutic agents, resulting in increased systemic toxicity. Many drugs require dose adjustment when administered in the setting of renal insufficiency (table 1). Minimizing nonrenal systemic toxicity may be a particular problem in patients on chronic hemodialysis, especially when the details of drug elimination and metabolism are not fully known [1].

The nephrotoxicity of different chemotherapy agents, preventive strategies, and recommended dose modifications in patients with renal insufficiency will be reviewed here. Immune-mediated renal toxicity associated with checkpoint inhibitor immunotherapy as used for advanced melanoma and non-small cell lung cancer (ie, ipilimumab, pembrolizumab, nivolumab), an overview of renal diseases associated with various cancers (including paraneoplastic syndromes), and the renal complications of tumor lysis syndrome and hematopoietic cell transplantation are discussed elsewhere. (See "Toxicities associated with checkpoint inhibitor immunotherapy", section on 'Kidney' and "Overview of kidney disease in the cancer patient" and "Tumor lysis syndrome: Definition, pathogenesis, clinical manifestations, etiology and risk factors" and "Kidney disease following hematopoietic cell transplantation".)


There are two principal pathways for drug excretion by the kidney: glomerular filtration and tubular secretion. Glomerular filtration plays a major role with non-protein-bound small molecules (ie, of a size that can pass through the glomerular capillary wall). Such molecules cannot be filtered if they are protein-bound in the circulation; these drugs, if they are renally excreted, enter the urine by secretion in the proximal tubule.

For those drugs in which renal excretion is an important determinant of elimination of the intact drug or an active metabolite, dose adjustment is often required if renal function is impaired. Although the prevalence of an elevated serum creatinine is low in cancer patients (<10 percent), the prevalence of a reduced glomerular filtration rate (GFR) is relatively high (50 to 53 percent in two cohort studies [2,3]).

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Sep 2017. | This topic last updated: Oct 25, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Boesler B, Czock D, Keller F, et al. Clinical course of haemodialysis patients with malignancies and dose-adjusted chemotherapy. Nephrol Dial Transplant 2005; 20:1187.
  2. Launay-Vacher V, Oudard S, Janus N, et al. Prevalence of Renal Insufficiency in cancer patients and implications for anticancer drug management: the renal insufficiency and anticancer medications (IRMA) study. Cancer 2007; 110:1376.
  3. Launay-Vacher V. Epidemiology of chronic kidney disease in cancer patients: lessons from the IRMA study group. Semin Nephrol 2010; 30:548.
  4. Launay-Vacher V, Chatelut E, Lichtman SM, et al. Renal insufficiency in elderly cancer patients: International Society of Geriatric Oncology clinical practice recommendations. Ann Oncol 2007; 18:1314.
  5. Matzke GR, Aronoff GR, Atkinson AJ Jr, et al. Drug dosing consideration in patients with acute and chronic kidney disease-a clinical update from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2011; 80:1122.
  6. Dooley MJ, Poole SG, Rischin D. Dosing of cytotoxic chemotherapy: impact of renal function estimates on dose. Ann Oncol 2013; 24:2746.
  7. Lichtman SM, Wildiers H, Launay-Vacher V, et al. International Society of Geriatric Oncology (SIOG) recommendations for the adjustment of dosing in elderly cancer patients with renal insufficiency. Eur J Cancer 2007; 43:14.
  8. Aronoff GM, Bennett WM, Berns JS, et al. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children, 5th, American College of Physicians, 2007.
  9. Janus N, Thariat J, Boulanger H, et al. Proposal for dosage adjustment and timing of chemotherapy in hemodialyzed patients. Ann Oncol 2010; 21:1395.
  10. Raj GV, Iasonos A, Herr H, Donat SM. Formulas calculating creatinine clearance are inadequate for determining eligibility for Cisplatin-based chemotherapy in bladder cancer. J Clin Oncol 2006; 24:3095.
  11. Kintzel PE, Dorr RT. Anticancer drug renal toxicity and elimination: dosing guidelines for altered renal function. Cancer Treat Rev 1995; 21:33.
  12. Tomita M, Kurata H, Aoki Y, et al. Pharmacokinetics of paclitaxel and cisplatin in a hemodialysis patient with recurrent ovarian cancer. Anticancer Drugs 2001; 12:485.
  13. Watanabe R, Takiguchi Y, Moriya T, et al. Feasibility of combination chemotherapy with cisplatin and etoposide for haemodialysis patients with lung cancer. Br J Cancer 2003; 88:25.
  14. Ribrag V, Droz JP, Morizet J, et al. Test dose-guided administration of cisplatin in an anephric patient: a case report. Ann Oncol 1993; 4:679.
  15. Ries F, Klastersky J. Nephrotoxicity induced by cancer chemotherapy with special emphasis on cisplatin toxicity. Am J Kidney Dis 1986; 8:368.
  16. McDonald BR, Kirmani S, Vasquez M, Mehta RL. Acute renal failure associated with the use of intraperitoneal carboplatin: a report of two cases and review of the literature. Am J Med 1991; 90:386.
  17. Vogelzang NJ. Nephrotoxicity from chemotherapy: prevention and management. Oncology (Williston Park) 1991; 5:97.
  18. Ettinger LJ, Gaynon PS, Krailo MD, et al. A phase II study of carboplatin in children with recurrent or progressive solid tumors. A report from the Childrens Cancer Group. Cancer 1994; 73:1297.
  19. Tscherning C, Rubie H, Chancholle A, et al. Recurrent renal salt wasting in a child treated with carboplatin and etoposide. Cancer 1994; 73:1761.
  20. Welborn J, Meyers FJ, O'Grady LF. Renal salt wasting and carboplatinum. Ann Intern Med 1988; 108:640.
  21. English MW, Lowis SP, Peng B, et al. Pharmacokinetically guided dosing of carboplatin and etoposide during peritoneal dialysis and haemodialysis. Br J Cancer 1996; 73:776.
  22. Chatelut E, Rostaing L, Gualano V, et al. Pharmacokinetics of carboplatin in a patient suffering from advanced ovarian carcinoma with hemodialysis-dependent renal insufficiency. Nephron 1994; 66:157.
  23. Motzer RJ, Niedzwiecki D, Isaacs M, et al. Carboplatin-based chemotherapy with pharmacokinetic analysis for patients with hemodialysis-dependent renal insufficiency. Cancer Chemother Pharmacol 1990; 27:234.
  24. Yanagawa H, Takishita Y, Bando H, et al. Carboplatin-based chemotherapy in patients undergoing hemodialysis. Anticancer Res 1996; 16:533.
  25. Inoue A, Saijo Y, Kikuchi T, et al. Pharmacokinetic analysis of combination chemotherapy with carboplatin and etoposide in small-cell lung cancer patients undergoing hemodialysis. Ann Oncol 2004; 15:51.
  26. Veal GJ, English MW, Grundy RG, et al. Pharmacokinetically guided dosing of carboplatin in paediatric cancer patients with bilateral nephrectomy. Cancer Chemother Pharmacol 2004; 54:295.
  27. http://nkdep.nih.gov/labprofessionals/Clinical_Laboratories.htm (Accessed on August 18, 2011).
  28. FDA safety alert available online at http://www.fda.gov/AboutFDA/CentersOffices/CDER/ucm228974.htm (Accessed on October 14, 2010).
  29. De Jonge ME, Mathôt RA, Van Dam SM, et al. Extremely high exposures in an obese patient receiving high-dose cyclophosphamide, thiotepa and carboplatin. Cancer Chemother Pharmacol 2002; 50:251.
  30. Lévi F, Metzger G, Massari C, Milano G. Oxaliplatin: pharmacokinetics and chronopharmacological aspects. Clin Pharmacokinet 2000; 38:1.
  31. Pinotti G, Martinelli B. A case of acute tubular necrosis due to oxaliplatin. Ann Oncol 2002; 13:1951.
  32. Labaye J, Sarret D, Duvic C, et al. Renal toxicity of oxaliplatin. Nephrol Dial Transplant 2005; 20:1275.
  33. Ulusakarya A, Misra S, Haydar M, et al. Acute renal failure related to oxaliplatin-induced intravascular hemolysis. Med Oncol 2010; 27:1425.
  34. Chollet P, Bensmaïne MA, Brienza S, et al. Single agent activity of oxaliplatin in heavily pretreated advanced epithelial ovarian cancer. Ann Oncol 1996; 7:1065.
  35. Takimoto CH, Remick SC, Sharma S, et al. Dose-escalating and pharmacological study of oxaliplatin in adult cancer patients with impaired renal function: a National Cancer Institute Organ Dysfunction Working Group Study. J Clin Oncol 2003; 21:2664.
  36. Horimatsu T, Miyamoto S, Morita S, et al. Pharmacokinetics of oxaliplatin in a hemodialytic patient treated with modified FOLFOX-6 plus bevacizumab therapy. Cancer Chemother Pharmacol 2011; 68:263.
  37. Owen JS, Melhem M, Passarell JA, et al. Bendamustine pharmacokinetic profile and exposure-response relationships in patients with indolent non-Hodgkin's lymphoma. Cancer Chemother Pharmacol 2010; 66:1039.
  38. Nordstrom BL, Knopf KB, Teltsch DY, et al. The safety of bendamustine in patients with chronic lymphocytic leukemia or non-Hodgkin lymphoma and concomitant renal impairment: a retrospective electronic medical record database analysis. Leuk Lymphoma 2014; 55:1266.
  39. DeFronzo RA, Colvin OM, Braine H, et al. Proceedings: Cyclophosphamide and the kidney. Cancer 1974; 33:483.
  40. Bode U, Seif SM, Levine AS. Studies on the antidiuretic effect of cyclophosphamide: vasopressin release and sodium excretion. Med Pediatr Oncol 1980; 8:295.
  41. Bressler RB, Huston DP. Water intoxication following moderate-dose intravenous cyclophosphamide. Arch Intern Med 1985; 145:548.
  42. Bramwell V, Calvert RT, Edwards G, et al. The disposition of cyclophosphamide in a group of myeloma patients. Cancer Chemother Pharmacol 1979; 3:253.
  43. Haubitz M, Bohnenstengel F, Brunkhorst R, et al. Cyclophosphamide pharmacokinetics and dose requirements in patients with renal insufficiency. Kidney Int 2002; 61:1495.
  44. Janků I, Modr Z, Krebs V. A set of simple aids to drug dosage adjustment in renal insufficiency. Int J Clin Pharmacol Ther Toxicol 1990; 28:27.
  45. Cancer Drug information from Cancer Care Ontario http://cancercare.on.ca/cms/one.aspx?portalId=1377&pageId=10760 (Accessed on September 14, 2017).
  46. Perry JJ, Fleming RA, Rocco MV, et al. Administration and pharmacokinetics of high-dose cyclophosphamide with hemodialysis support for allogeneic bone marrow transplantation in acute leukemia and end-stage renal disease. Bone Marrow Transplant 1999; 23:839.
  47. Farry JK, Flombaum CD, Latcha S. Long term renal toxicity of ifosfamide in adult patients--5 year data. Eur J Cancer 2012; 48:1326.
  48. Harmon WE, Cohen HJ, Schneeberger EE, Grupe WE. Chronic renal failure in children treated with methyl CCNU. N Engl J Med 1979; 300:1200.
  49. Narins RG, Carley M, Bloom EJ, Harrison DS. The nephrotoxicity of chemotherapeutic agents. Semin Nephrol 1990; 10:556.
  50. Sponzo RW, DeVita VT, Oliverio VT. Physiologic disposition of 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) and 1-(2-chloroethyl)-3-(4-methyl cyclohexyl)-1-nitrosourea (Me CCNU) in man. Cancer 1973; 31:1154.
  51. Weiss RB, Posada JG Jr, Kramer RA, Boyd MR. Nephrotoxicity of semustine. Cancer Treat Rep 1983; 67:1105.
  52. Micetich KC, Jensen-Akula M, Mandard JC, Fisher RI. Nephrotoxicity of semustine (methyl-CCNU) in patients with malignant melanoma receiving adjuvant chemotherapy. Am J Med 1981; 71:967.
  53. Schacht RG, Feiner HD, Gallo GR, et al. Nephrotoxicity of nitrosoureas. Cancer 1981; 48:1328.
  54. Sadoff L. Nephrotoxicity of streptozotocin (NSC-85998). Cancer Chemother Rep 1970; 54:457.
  55. Myerowitz RL, Sartiano GP, Cavallo T. Nephrotoxic and cytoproliferative effects of streptozotocin: report of a patient with multiple hormone-secreting islet cell carcinoma. Cancer 1976; 38:1550.
  56. Hricik DE, Goldsmith GH. Uric acid nephrolithiasis and acute renal failure secondary to streptozotocin nephrotoxicity. Am J Med 1988; 84:153.
  57. Delaney V, de Pertuz Y, Nixon D, Bourke E. Indomethacin in streptozocin-induced nephrogenic diabetes insipidus. Am J Kidney Dis 1987; 9:79.
  58. Broder LE, Carter SK. Pancreatic islet cell carcinoma. II. Results of therapy with streptozotocin in 52 patients. Ann Intern Med 1973; 79:108.
  59. Tobin MV, Warenius HM, Morris AI. Forced diuresis to reduce nephrotoxicity of streptozotocin in the treatment of advanced metastatic insulinoma. Br Med J (Clin Res Ed) 1987; 294:1128.
  60. Jen JF, Cutler DL, Pai SM, et al. Population pharmacokinetics of temozolomide in cancer patients. Pharm Res 2000; 17:1284.
  61. Greenbaum-Lefkoe B, Rosenstock JG, Belasco JB, et al. Syndrome of inappropriate antidiuretic hormone secretion. A complication of high-dose intravenous melphalan. Cancer 1985; 55:44.
  62. Helson L, Sadof MD, Wernovsky G, Gulati S. L-phenylalanine mustard-dianhydrogalactitol and hyponatremia. Pediatr Hematol Oncol 1986; 3:287.
  63. Badros A, Barlogie B, Siegel E, et al. Results of autologous stem cell transplant in multiple myeloma patients with renal failure. Br J Haematol 2001; 114:822.
  64. Carlson K, Hjorth M, Knudsen LM, Nordic Myeloma Study Group. Toxicity in standard melphalan-prednisone therapy among myeloma patients with renal failure--a retrospective analysis and recommendations for dose adjustment. Br J Haematol 2005; 128:631.
  65. Price TM, Murgo AJ, Keveney JJ, et al. Renal failure and hemolytic anemia associated with mitomycin C. A case report. Cancer 1985; 55:51.
  66. Poch E, González-Clemente JM, Torras A, et al. Silent renal microangiography after mitomycin C therapy. Am J Nephrol 1990; 10:514.
  67. Cantrell JE Jr, Phillips TM, Schein PS. Carcinoma-associated hemolytic-uremic syndrome: a complication of mitomycin C chemotherapy. J Clin Oncol 1985; 3:723.
  68. Groff JA, Kozak M, Boehmer JP, et al. Endotheliopathy: a continuum of hemolytic uremic syndrome due to mitomycin therapy. Am J Kidney Dis 1997; 29:280.
  69. Jackson AM, Rose BD, Graff LG, et al. Thrombotic microangiopathy and renal failure associated with antineoplastic chemotherapy. Ann Intern Med 1984; 101:41.
  70. Lesesne JB, Rothschild N, Erickson B, et al. Cancer-associated hemolytic-uremic syndrome: analysis of 85 cases from a national registry. J Clin Oncol 1989; 7:781.
  71. Valavaara R, Nordman E. Renal complications of mitomycin C therapy with special reference to the total dose. Cancer 1985; 55:47.
  72. Cattell V. Mitomycin-induced hemolytic uremic kidney. An experimental model in the rat. Am J Pathol 1985; 121:88.
  73. Garibotto G, Acquarone N, Saffioti S, et al. Successful treatment of mitomycin C-associated hemolytic uremic syndrome by plasmapheresis. Nephron 1989; 51:409.
  74. Poch E, Almirall J, Nicolas JM, et al. Treatment of mitomycin-C-associated hemolytic uremic syndrome with plasmapheresis. Nephron 1990; 55:89.
  75. Snyder HW Jr, Mittelman A, Oral A, et al. Treatment of cancer chemotherapy-associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome by protein A immunoadsorption of plasma. Cancer 1993; 71:1882.
  76. Dorr RT. Bleomycin pharmacology: mechanism of action and resistance, and clinical pharmacokinetics. Semin Oncol 1992; 19:3.
  77. Bennett WM, Pastore L, Houghton DC. Fatal pulmonary bleomycin toxicity in cisplatin-induced acute renal failure. Cancer Treat Rep 1980; 64:921.
  78. McLeod BF, Lawrence HJ, Smith DW, et al. Fatal bleomycin toxicity from a low cumulative dose in a patient with renal insufficiency. Cancer 1987; 60:2617.
  79. Balducci L, Mowry K. Pharmacology and organ toxicity of chemotherapy in older patients. Oncology (Williston Park) 1992; 6:62.
  80. Howell SB, Carmody J. Changes in glomerular filtration rate associated with high-dose methotrexate therapy in adults. Cancer Treat Rep 1977; 61:1389.
  81. Schilsky RL. Renal and metabolic toxicities of cancer treatment. In: Toxicity of chemotherapy, Perry MC, Yarbro JW (Eds), Grune & Stratton, Philadelphi 1984. p.317.
  82. Bowyer GW, Davies TW. Methotrexate toxicity associated with an ileal conduit. Br J Urol 1987; 60:592.
  83. Stavroulopoulos A, Nakopoulou L, Xydakis AM, et al. Interstitial nephritis and nephrogenic diabetes insipidus in a patient treated with pemetrexed. Ren Fail 2010; 32:1000.
  84. Vootukuru V, Liew YP, Nally JV Jr. Pemetrexed-induced acute renal failure, nephrogenic diabetes insipidus, and renal tubular acidosis in a patient with non-small cell lung cancer. Med Oncol 2006; 23:419.
  85. Mita AC, Sweeney CJ, Baker SD, et al. Phase I and pharmacokinetic study of pemetrexed administered every 3 weeks to advanced cancer patients with normal and impaired renal function. J Clin Oncol 2006; 24:552.
  86. Lathia C, Fleming GF, Meyer M, et al. Pentostatin pharmacokinetics and dosing recommendations in patients with mild renal impairment. Cancer Chemother Pharmacol 2002; 50:121.
  87. Lichtman SM, Etcubanas E, Budman DR, et al. The pharmacokinetics and pharmacodynamics of fludarabine phosphate in patients with renal impairment: a prospective dose adjustment study. Cancer Invest 2002; 20:904.
  88. Izzedine H, Isnard-Bagnis C, Launay-Vacher V, et al. Gemcitabine-induced thrombotic microangiopathy: a systematic review. Nephrol Dial Transplant 2006; 21:3038.
  89. Glezerman I, Kris MG, Miller V, et al. Gemcitabine nephrotoxicity and hemolytic uremic syndrome: report of 29 cases from a single institution. Clin Nephrol 2009; 71:130.
  90. Saif MW, Xyla V, Makrilia N, et al. Thrombotic microangiopathy associated with gemcitabine: rare but real. Expert Opin Drug Saf 2009; 8:257.
  91. Leal F, Macedo LT, Carvalheira JB. Gemcitabine-related thrombotic microangiopathy: a single-centre retrospective series. J Chemother 2014; 26:169.
  92. Venook AP, Egorin MJ, Rosner GL, et al. Phase I and pharmacokinetic trial of gemcitabine in patients with hepatic or renal dysfunction: Cancer and Leukemia Group B 9565. J Clin Oncol 2000; 18:2780.
  93. Matsuda M. Gemcitabine for patients with chronic renal failure on hemodialysis (abstract #15189). J Clin Oncol 2007; 25:15189.
  94. Smith GA, Damon LE, Rugo HS, et al. High-dose cytarabine dose modification reduces the incidence of neurotoxicity in patients with renal insufficiency. J Clin Oncol 1997; 15:833.
  95. Cutting HO. Inappropriate secretion of antidiuretic hormone secondary to vincristine therapy. Am J Med 1971; 51:269.
  96. Garrett CA, Simpson TA Jr. Syndrome of inappropriate antidiuretic hormone associated with vinorelbine therapy. Ann Pharmacother 1998; 32:1306.
  97. O'Reilly S, Rowinsky EK, Slichenmyer W, et al. Phase I and pharmacologic study of topotecan in patients with impaired renal function. J Clin Oncol 1996; 14:3062.
  98. Furuya Y, Takihana Y, Araki I, et al. [Pharmacokinetics of paclitaxel and carboplatin in a hemodialysis patient with metastatic urothelial carcinoma--a case report]. Gan To Kagaku Ryoho 2003; 30:1017.
  99. Watanabe M, Aoki Y, Tomita M, et al. Paclitaxel and carboplatin combination chemotherapy in a hemodialysis patient with advanced ovarian cancer. Gynecol Oncol 2002; 84:335.
  100. Baur M, Fazeny-Doerner B, Olsen SJ, Dittrich C. High dose single-agent paclitaxel in a hemodialysis patient with advanced ovarian cancer: a case report with pharmacokinetic analysis and review of the literature. Int J Gynecol Cancer 2008; 18:564.
  101. Mencoboni M, Olivieri R, Vannozzi MO, et al. Docetaxel pharmacokinetics with pre- and post-dialysis administration in a hemodyalized patient. Chemotherapy 2006; 52:147.
  102. US FDA labeling information for cabazitaxel available at http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=19208 (Accessed on July 13, 2010).
  103. Sparreboom A, de Jonge MJ, de Bruijn P, et al. Irinotecan (CPT-11) metabolism and disposition in cancer patients. Clin Cancer Res 1998; 4:2747.
  104. Vénat-Bouvet L, Saint-Marcoux F, Lagarde C, et al. Irinotecan-based chemotherapy in a metastatic colorectal cancer patient under haemodialysis for chronic renal dysfunction: two cases considered. Anticancer Drugs 2007; 18:977.
  105. Shinozaki E, Mizunuma N, Tanabe M, et al. [Induction of CPT-11 in a patient on hemodialysis with metastatic rectal cancer]. Gan To Kagaku Ryoho 2005; 32:397.
  106. Ashizawa T, Iwahori T, Yokoyama T, et al. Irinotecan hydrochloride (CPT-11) in dialysis patients with gastrointestinal cancer. Acta Med Okayama 2010; 64:19.
  107. Czock D, Rasche FM, Boesler B, et al. Irinotecan in cancer patients with end-stage renal failure. Ann Pharmacother 2009; 43:363.
  108. Chen N, Lau H, Kong L, et al. Pharmacokinetics of lenalidomide in subjects with various degrees of renal impairment and in subjects on hemodialysis. J Clin Pharmacol 2007; 47:1466.
  109. Niesvizky R, Naib T, Christos PJ, et al. Lenalidomide-induced myelosuppression is associated with renal dysfunction: adverse events evaluation of treatment-naïve patients undergoing front-line lenalidomide and dexamethasone therapy. Br J Haematol 2007; 138:640.
  110. Dimopoulos M, Alegre A, Stadtmauer EA, et al. The efficacy and safety of lenalidomide plus dexamethasone in relapsed and/or refractory multiple myeloma patients with impaired renal function. Cancer 2010; 116:3807.
  111. Lipson EJ, Huff CA, Holanda DG, et al. Lenalidomide-induced acute interstitial nephritis. Oncologist 2010; 15:961.
  112. Batts ED, Sanchorawala V, Hegerfeldt Y, Lazarus HM. Azotemia associated with use of lenalidomide in plasma cell dyscrasias. Leuk Lymphoma 2008; 49:1108.
  113. Synold, TW, Tsao-Wei, DD, Quinn, DI, et al. Phase I and pharmacokinetic (PK) study of eribulin (E7389) in patients (pts) with renal dysfunction (RD) and advanced urothelial cancer (UC): A California Cancer Consortium Trial (abstract 2527). J clin Oncol 2010; 28:210s. Abstract available online at http://www.asco.org/ascov2/Meetings/Abstracts?&vmview=abst_detail_view&confID=74&abstractID=49636 (Accessed on February 07, 2011).
  114. Prescribing information for Arsenic trioxide available online at http://www.trisenox.com/pdf/TRISENOX_pi.pdf (Accessed on October 07, 2010).
  115. US Prescribing information for ixazomib available online at http://www.accessdata.fda.gov/drugsatfda_docs/label/2015/208462lbl.pdf (Accessed on December 04, 2015).
  116. Launay-Vacher V, Aapro M, De Castro G Jr, et al. Renal effects of molecular targeted therapies in oncology: a review by the Cancer and the Kidney International Network (C-KIN). Ann Oncol 2015; 26:1677.
  117. Khan G, Golshayan A, Elson P, et al. Sunitinib and sorafenib in metastatic renal cell carcinoma patients with renal insufficiency. Ann Oncol 2010; 21:1618.
  118. Gupta S, Parsa V, Heilbrun LK, et al. Safety and efficacy of molecularly targeted agents in patients with metastatic kidney cancer with renal dysfunction. Anticancer Drugs 2011; 22:794.
  119. Miller AA, Murry DJ, Owzar K, et al. Phase I and pharmacokinetic study of sorafenib in patients with hepatic or renal dysfunction: CALGB 60301. J Clin Oncol 2009; 27:1800.
  120. Kennoki T, Kondo T, Kimata N, et al. Clinical results and pharmacokinetics of sorafenib in chronic hemodialysis patients with metastatic renal cell carcinoma in a single center. Jpn J Clin Oncol 2011; 41:647.
  121. Masini C, Sabbatini R, Porta C, et al. Use of tyrosine kinase inhibitors in patients with metastatic kidney cancer receiving haemodialysis: a retrospective Italian survey. BJU Int 2012; 110:692.
  122. Rey PM, Villavicencio H. Sorafenib: tolerance in patients on chronic hemodialysis: a single-center experience. Oncology 2008; 74:245.
  123. Khosravan R, Toh M, Garrett M, et al. Pharmacokinetics and safety of sunitinib malate in subjects with impaired renal function. J Clin Pharmacol 2010; 50:472.
  124. Izzedine H, Etienne-Grimaldi MC, Renée N, et al. Pharmacokinetics of sunitinib in hemodialysis. Ann Oncol 2009; 20:190.
  125. Josephs D, Hutson TE, Cowey CL, et al. Efficacy and toxicity of sunitinib in patients with metastatic renal cell carcinoma with severe renal impairment or on haemodialysis. BJU Int 2011; 108:1279.
  126. Kim KH, Kim HY, Kim HR, et al. Efficacy and toxicity of sunitinib in patients with metastatic renal cell carcinoma with renal insufficiency. Eur J Cancer 2014; 50:746.
  127. Rossi A, Maione P, Del Gaizo F, et al. Safety profile of gefitinib in advanced non-small cell lung cancer elderly patients with chronic renal failure: two clinical cases. Lung Cancer 2005; 47:421.
  128. Miller AA, Murry DJ, Owzar K, et al. Phase I and pharmacokinetic study of erlotinib for solid tumors in patients with hepatic or renal dysfunction: CALGB 60101. J Clin Oncol 2007; 25:3055.
  129. Togashi Y, Masago K, Fukudo M, et al. Pharmacokinetics of erlotinib and its active metabolite OSI-420 in patients with non-small cell lung cancer and chronic renal failure who are undergoing hemodialysis. J Thorac Oncol 2010; 5:601.
  130. Fontana E, Pucci F, Ardizzoni A. Colorectal cancer patient on maintenance dialysis successfully treated with cetuximab. Anticancer Drugs 2014; 25:120.
  131. Schrag D, Chung KY, Flombaum C, Saltz L. Cetuximab therapy and symptomatic hypomagnesemia. J Natl Cancer Inst 2005; 97:1221.
  132. Tejpar S, Piessevaux H, Claes K, et al. Magnesium wasting associated with epidermal-growth-factor receptor-targeting antibodies in colorectal cancer: a prospective study. Lancet Oncol 2007; 8:387.
  133. Groenestege WM, Thébault S, van der Wijst J, et al. Impaired basolateral sorting of pro-EGF causes isolated recessive renal hypomagnesemia. J Clin Invest 2007; 117:2260.
  134. Thatcher N, Hirsch FR, Luft AV, et al. Necitumumab plus gemcitabine and cisplatin versus gemcitabine and cisplatin alone as first-line therapy in patients with stage IV squamous non-small-cell lung cancer (SQUIRE): an open-label, randomised, controlled phase 3 trial. Lancet Oncol 2015; 16:763.
  135. Cao Y, Liao C, Tan A, et al. Meta-analysis of incidence and risk of hypomagnesemia with cetuximab for advanced cancer. Chemotherapy 2010; 56:459.
  136. Vickers MM, Karapetis CS, Tu D, et al. Association of hypomagnesemia with inferior survival in a phase III, randomized study of cetuximab plus best supportive care versus best supportive care alone: NCIC CTG/AGITG CO.17. Ann Oncol 2013; 24:953.
  137. Vincenzi B, Santini D, Galluzzo S, et al. Early magnesium reduction in advanced colorectal cancer patients treated with cetuximab plus irinotecan as predictive factor of efficacy and outcome. Clin Cancer Res 2008; 14:4219.
  138. Vincenzi B, Galluzzo S, Santini D, et al. Early magnesium modifications as a surrogate marker of efficacy of cetuximab-based anticancer treatment in KRAS wild-type advanced colorectal cancer patients. Ann Oncol 2011; 22:1141.
  139. Cao Y, Liu L, Liao C, et al. Meta-analysis of incidence and risk of hypokalemia with cetuximab-based therapy for advanced cancer. Cancer Chemother Pharmacol 2010; 66:37.
  140. Ben Salem C, Hmouda H, Bouraoui K. Drug-induced hypokalaemia. Curr Drug Saf 2009; 4:55.
  141. Marcolino MS, Boersma E, Clementino NC, et al. Imatinib treatment duration is related to decreased estimated glomerular filtration rate in chronic myeloid leukemia patients. Ann Oncol 2011; 22:2073.
  142. Gafter-Gvili A, Ram R, Gafter U, et al. Renal failure associated with tyrosine kinase inhibitors--case report and review of the literature. Leuk Res 2010; 34:123.
  143. Pou M, Saval N, Vera M, et al. Acute renal failure secondary to imatinib mesylate treatment in chronic myeloid leukemia. Leuk Lymphoma 2003; 44:1239.
  144. Yuzawa Y, Sato W, Masuda T, et al. Acute kidney injury presenting a feature of leukemic infiltration during therapy for chronic myelogenous leukemia. Intern Med 2010; 49:1139.
  145. Gibbons J, Egorin MJ, Ramanathan RK, et al. Phase I and pharmacokinetic study of imatinib mesylate in patients with advanced malignancies and varying degrees of renal dysfunction: a study by the National Cancer Institute Organ Dysfunction Working Group. J Clin Oncol 2008; 26:570.
  146. Pappas P, Karavasilis V, Briasoulis E, et al. Pharmacokinetics of imatinib mesylate in end stage renal disease. A case study. Cancer Chemother Pharmacol 2005; 56:358.
  147. Ozdemir E, Koc Y, Kansu E. Successful treatment of chronic myeloid leukemia with imatinib mesylate in a patient with chronic renal failure on hemodialysis. Am J Hematol 2006; 81:474.
  148. Yang H, Rosove MH, Figlin RA. Tumor lysis syndrome occurring after the administration of rituximab in lymphoproliferative disorders: high-grade non-Hodgkin's lymphoma and chronic lymphocytic leukemia. Am J Hematol 1999; 62:247.
  149. Jensen M, Winkler U, Manzke O, et al. Rapid tumor lysis in a patient with B-cell chronic lymphocytic leukemia and lymphocytosis treated with an anti-CD20 monoclonal antibody (IDEC-C2B8, rituximab). Ann Hematol 1998; 77:89.
  150. Brosnan EM, Weickhardt AJ, Lu X, et al. Drug-induced reduction in estimated glomerular filtration rate in patients with ALK-positive non-small cell lung cancer treated with the ALK inhibitor crizotinib. Cancer 2014; 120:664.
  151. Camidge DR, Brosnan EM, DeSilva C, et al. Crizotinib effects on creatinine and non-creatinine-based measures of glomerular filtration rate. J Thorac Oncol 2014; 9:1634.
  152. Lunardi G, Vannozzi MO, Armirotti A, et al. Temsirolimus in patients with renal cancer on hemodialysis. J Clin Oncol 2008; 26:5652.
  153. Wang ML, Rule S, Martin P, et al. Targeting BTK with ibrutinib in relapsed or refractory mantle-cell lymphoma. N Engl J Med 2013; 369:507.
  154. Jhaveri KD, Sakhiya V, Fishbane S. Nephrotoxicity of the BRAF Inhibitors Vemurafenib and Dabrafenib. JAMA Oncol 2015; 1:1133.
  155. Belldegrun A, Webb DE, Austin HA 3rd, et al. Effects of interleukin-2 on renal function in patients receiving immunotherapy for advanced cancer. Ann Intern Med 1987; 106:817.
  156. Mercatello A, Hadj-Aïssa A, Négrier S, et al. Acute renal failure with preserved renal plasma flow induced by cancer immunotherapy. Kidney Int 1991; 40:309.
  157. Guleria AS, Yang JC, Topalian SL, et al. Renal dysfunction associated with the administration of high-dose interleukin-2 in 199 consecutive patients with metastatic melanoma or renal carcinoma. J Clin Oncol 1994; 12:2714.
  158. Memoli B, De Nicola L, Libetta C, et al. Interleukin-2-induced renal dysfunction in cancer patients is reversed by low-dose dopamine infusion. Am J Kidney Dis 1995; 26:27.
  159. Selby P, Kohn J, Raymond J, et al. Nephrotic syndrome during treatment with interferon. Br Med J (Clin Res Ed) 1985; 290:1180.
  160. Zuber J, Martinez F, Droz D, et al. Alpha-interferon-associated thrombotic microangiopathy: a clinicopathologic study of 8 patients and review of the literature. Medicine (Baltimore) 2002; 81:321.
  161. Ault BH, Stapleton FB, Gaber L, et al. Acute renal failure during therapy with recombinant human gamma interferon. N Engl J Med 1988; 319:1397.