Dialysis in TLS

Q: Which of the following is NOT an indication for early dialysis in patients with Tumor Lysis Syndrome (TLS)? (select one)

A) hyperkalemia

B) Hyperphosphatemia

C) hypercalcemia

D) High uric acid

Answer: C

The objective of this question is to highlight the low threshold of initiating dialysis in patients who develop TLS. This low threshold is due to two reasons:

1. Hyperkalemia occurs relatively fast in TLS due to rapid potassium release and can be fatal with superimposed oliguria. 

2. Rapid reduction of uric acid and phosphate levels is vital in preventing End-Stage Renal Disease (ESRD).

Usually, symptomatic hypocalcemia (not hypercalcemia) is a norm in TLS. This is due to hyperphosphatemia (choice C).

#nephrology

#oncology

References:

1. Cairo MS, Bishop M. Tumour lysis syndrome: new therapeutic strategies and classification. Br J Haematol 2004; 127:3.

2. Tan HK, Bellomo R, M'Pis DA, Ronco C. Phosphatemic control during acute renal failure: intermittent hemodialysis versus continuous hemodiafiltration. Int J Artif Organs 2001; 24:186.