The Use of Extracorporeal Organ Support Therapies for Acute Kidney Injury in Cancer Patients

Abstract

Acute kidney injury (AKI) is a frequent and serious complication in patients with cancer, associated not only with increased morbidity and mortality, but also with the interruption or modification of anticancer therapy. In critically ill patients with cancer, AKI arises from a complex interplay of cancer-related, treatment-related, and patient-related factors, with many patients requiring renal replacement therapy (RRT) and admission to the intensive care unit (ICU). This narrative review summarizes the etiology of AKI in patients with cancer and discusses the role of extracorporeal organ support (ECOS) therapies, with particular emphasis on continuous renal replacement therapy (CRRT). Understanding the underlying etiology of AKI in this patient population is essential for guiding treatment decisions, particularly when therapeutic plasma exchange, hemadsorption, or other extracorporeal modalities are considered which may directly target the pathophysiology driving organ dysfunction. Although observational data suggest that ECOS use may improve both short- and long-term outcomes, robust evidence demonstrating consistent benefit remains lacking. Furthermore, limited pharmacokinetic data for anticancer drugs in patients undergoing dialysis or RRT creates significant uncertainty regarding optimal dosing strategies. By providing a structured overview of extracorporeal organ support strategies in cancer-associated AKI, this review aims to support multidisciplinary decision-making and facilitate more individualized critical care for this high-risk population.