Tumor Lysis Syndrome & Dialysis
When cancer treatment works rapidly, the sudden release of cellular contents can overwhelm the kidneys. Our team provides urgent dialysis support for TLS emergencies in leukemia, lymphoma, and other high-risk malignancies.
What is Tumor Lysis Syndrome?
Tumor lysis syndrome (TLS) is an oncologic emergency that occurs when large numbers of cancer cells die rapidly, releasing their intracellular contents into the bloodstream. This typically happens after initiating chemotherapy, targeted therapy, or immunotherapy for highly proliferative malignancies.
The sudden release of potassium, phosphorus, and nucleic acids (which convert to uric acid) overwhelms the body's ability to clear these substances, leading to life-threatening metabolic derangements.
The TLS Cascade
- 1Tumor cells lyse (burst) releasing cellular contents
- 2Potassium, phosphorus, and uric acid levels spike
- 3Calcium drops (binds to excess phosphorus)
- 4Uric acid and calcium-phosphate crystals precipitate in kidney tubules
- 5Acute kidney injury develops, worsening the metabolic crisis
TLS Diagnostic Criteria
Laboratory TLS (Cairo-Bishop criteria) requires ≥2 of:
Clinical TLS = Laboratory TLS + one or more: creatinine ≥1.5x ULN, cardiac arrhythmia, seizure, or death
High-Risk Malignancies
TLS risk varies by tumor type, burden, and sensitivity to treatment
High Risk
- Burkitt lymphoma
- Acute lymphoblastic leukemia (ALL)
- Acute myeloid leukemia (high WBC)
- High-grade lymphomas with bulky disease
Intermediate Risk
- Diffuse large B-cell lymphoma
- Other acute leukemias
- Multiple myeloma (rare)
- Rapidly proliferating solid tumors
Lower Risk
- Chronic lymphocytic leukemia
- Indolent lymphomas
- Most solid tumors
- Treated with non-cytotoxic therapies
Our Approach to TLS
Rapid response nephrology support for oncology emergencies
Prevention Support
Pre-treatment risk assessment and aggressive hydration protocols. Coordination with oncology for rasburicase and allopurinol prophylaxis.
Rapid Response
On-site dialysis initiation within hours for established TLS. Pre-positioned equipment at partner cancer centers.
Metabolic Correction
Emergent dialysis for life-threatening hyperkalemia and severe metabolic derangements that don't respond to medical therapy.
CRRT for Unstable Patients
Continuous therapy for hemodynamically unstable patients or those needing prolonged metabolic control.
Ongoing Monitoring
Close collaboration with oncology team. Serial labs and dialysis as needed during the high-risk period.
Recovery Planning
Most TLS-related AKI is reversible. We monitor for kidney recovery and coordinate transition off dialysis.
When to Call for Nephrology Support
Early nephrology involvement improves outcomes in TLS. Don't wait until dialysis is emergently needed—call us when TLS is developing.
Dialysis Indications in TLS
Absolute Indications
- • Symptomatic hyperkalemia (arrhythmia, weakness)
- • Potassium >7.0 mEq/L refractory to medical Rx
- • Severe volume overload with pulmonary edema
- • Uremic symptoms (encephalopathy, pericarditis)
Consider Dialysis
- • Rapidly rising creatinine despite hydration
- • Persistent severe hyperuricemia
- • Need for volume removal to continue hydration
- • Preparation for ongoing high-risk treatment
Frequently Asked Questions
Can chemotherapy continue during dialysis for TLS?
This is a case-by-case decision made with the oncology team. Often, chemotherapy continues with dialysis support for metabolic control. For some rapidly proliferative diseases, stopping treatment can be more dangerous than continuing with renal support.
Does rasburicase eliminate the need for dialysis?
Rasburicase dramatically reduces hyperuricemia and has decreased TLS-related dialysis rates. However, it doesn't address hyperkalemia, hyperphosphatemia, or established AKI. Dialysis is still needed for these complications or when rasburicase fails to control uric acid.
How long do TLS patients typically need dialysis?
TLS-related AKI is usually reversible. Most patients need dialysis for days to 2 weeks while the acute tumor lysis resolves and kidneys recover. Chronic dialysis is uncommon unless there was pre-existing kidney disease.
What's the mortality rate for TLS requiring dialysis?
TLS with AKI significantly increases mortality compared to TLS without AKI. However, outcomes have improved with aggressive prevention, rasburicase, and early dialysis when needed. The underlying malignancy and overall patient condition also heavily influence outcomes.
Partner With Us for Oncology Nephrology
Whether you have an active TLS case or want to establish nephrology support for your oncology program, we're here to help. Contact us for a consultation.