Table 3.
| Agent | Creatinine clearance (mL/min) |
Haemodialysis | ||
|---|---|---|---|---|
| 90–60 | 60–30 | 30–15 | ||
| Bleomycin | 100% | 75% | 75% | 50%a |
| Capecitabine | 100% | 75% | Avoid | Avoid |
| Carboplatin | Dosing based on AUC. Calvert formula: total carboplatin dose, mg = target AUC × (eGFR + 25). AUC varies between 5 (treated patients) and 7 mg/mL min (untreated patients) | In dialysis patients, consider GFR = 0 and the target dose = 125–175 mg. E: 84 ± 3%b | ||
| Carmustine | 100% | 80% if CrCl ≥45; 75% if CrCl <45 | Consider alternative | Consider alternative |
| Cisplatin | 100% | 50% | 50% | 25–50%b |
| Crizotinib | 100% | 100% | 50% | NA |
| Cyclophosphamide | 100% | 75–100% | 75% | 75%a—E:40–90% |
| Cytarabine (high dose) | 100% | 60% if CrCl ≥45; 50% if CrCl <45 | 30% or consider alternative | 30% consider alternativea |
| Dacarbazine | 100% | 80–70% | NA | 100 mg daily for 5 days per cycle |
| Eribulin | 100% | ≥40 mL/min: 100%; <40 mL/min: NA | NA | NA |
| Etoposide | 100% | 75% | 75% | 50%c |
| Fludarabine | 100% | 80% (USA); 50% (UK) | Avoid | Avoid |
| Hydroxyurea | 100% | 50% | 50% | 20%b |
| Ifosfamide | 100% | 75–100% | 75–100% | 75%,b E: 87% |
| Irinotecan | 100% | NA | NA | 30–40% |
| Lenalidomide | 25 mg daily | 10 mg daily | 15 mg every 2 days | 15 mg every 2 days—E:31%b |
| Lomustine | 100% | 75% | 75% | 25–50% |
| Melphalan | 100% | 75% | 75% | 50%a |
| Methotrexate | 100% | 80% | 50% | Avoid—HD Cl: from 82 to 102 mL/minb |
| Mitomycin | 100% | 100% | 100% | 75%a |
| Oxaliplatin | 100% | 100% | Avoid if CrCl <30 (Canadian) or <20 (USA) | Avoid |
| Pentazocine | 100% | 66% | 66% | 50% |
| Pentostatin | 100% | 50–75% | 50% | 50% (1–2 h before the dialysis session) |
| Pemetrexed | 100% | 100% | Avoid | Avoid |
| Regorafenib | 100% | 100% | NA | NA |
| Sorafenib | 100% | 100% | 100% | 25% of the dose and increase to 100% according to clinical safety and efficacyc |
| Sunitinib | 100% | 100% | 100% | 25% then increase to 100% according to clinical safety and efficacy. E: 0c |
| Topotecan | 100% | 50% | 50% | 25%b |
| Vandetanib | 100% | 25% | NA | NA |
AUC, target area under the concentration versus time curve in mg/mL•min; E, extraction coefficient (%); NA, not available.
aIn the absence of data on its removal during dialysis, the drug will be administered after the session, the haemodialysis days.
bThe drug is dialyzable. Therefore, it will be administered after the session, the days with HD.
cThe drug may be administered indifferently before or after the haemodialysis session.