Acute hemodialysis for cancer-associated acute kidney injury: etiologies, indications, and outcomes from a 25-year single-center experience

Acute kidney injury (AKI) is a common and life-threatening complication in cancer patients, often leading to treatment interruption and increased mortality. When AKI progresses to the stage requiring hemodialysis, the prognosis becomes particularly poor. This study aimed to evaluate the etiologies, dialysis indications, and outcomes of malignancy-associated AKI requiring emergency hemodialysis over 25 years. This retrospective study included adult patients with malignancies who underwent emergency hemodialysis for AKI at a tertiary referral center between January 2000 and March 2025. Patients were categorized into five malignancy groups-respiratory, hematologic, gastrointestinal, genitourinary, and other-and stratified by two time periods (2000-2010 and 2011-2025), representing the eras of conventional chemotherapy and targeted or immune-based therapies, respectively. Among 2,490 patients who underwent emergency hemodialysis, 539 (21.6%) had malignancies. The median age was 63 years, and 59% of the participants were male. Genitourinary cancers (38%) were the most frequent, followed by hematologic (24%) and gastrointestinal (22%) malignancies. Postrenal obstruction (37%) was the leading etiology of AKI, while uremia (34%) and hyperkalemia (23%) were the main dialysis indications. The median number of dialysis sessions was 4 (range, 1-89), and dialysis independence was achieved in 56% of patients. After 2010, postrenal obstruction and hypercalcemia-related AKI increased, whereas uremia declined, and renal recovery improved significantly. In conclusion, this study provides real-world data on cancer-associated AKI requiring emergency hemodialysis, demonstrating heterogeneity in etiologies and dialysis indications across malignancy types. Temporal improvements in renal recovery suggest better kidney outcomes over time, emphasizing the need for optimized management and multidisciplinary care.