https://doi.org/10.1177/2399369320976657 Journal of Onco-Nephrology 1–8 © The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/2399369320976657 journals.sagepub.com/home/jnp JON Journal of Onco-Nephrology Introduction Substantial progress has been made in treating cancer over the last decades, for many cancers the overall mortality has decreased. However, both acute kidney injury (AKI) and chronic kidney disease (CKD) are common in cancer patients. This may occur as a consequence of the cancer itself (multiple myeloma, urinary obstruction, diffuse intravascular coagulation), its treatment (tumor lysis syn- drome, drug-induced nephropathy, surgery) or severe complications (dehydration, sepsis, contrast nephropathy). As such, the benefit of cancer therapy on overall survival needs to be seen against the high frequency of therapy- associated organ failure and high treatment burden, taken into account the age of the treated population. The aim of this article is to review the incidence and prevalence of AKI and CKD in cancer patients and to highlight the effect on clinical outcome. Given this knowledge we aim to pro- vide tools to guide practitioners in the decision-making process whether or not to start RRT. AKI in cancer patients The incidence of AKI in hospitalized patients with cancer is higher than in the non-cancer population. In a How to use dialysis wisely in cancer patients? Annelien van der Veen 1 , Katrien De Vusser 1 , Bart De Moor 2,3 , Hans Wildiers 4,5 , Laura Cosmai 6 and Ben Sprangers 1,7,8 Abstract Both acute kidney injury (AKI) and chronic kidney disease (CKD) are common in cancer patients and are associated with inferior outcome, higher mortality rates, longer hospital stays and higher costs. In the aging population, the prevalence of both cancer and end-stage renal disease increase and practitioners are faced with difficult decisions regarding initiation of anticancer therapy and renal replacement therapy (RRT). Recent studies have shown no survival benefit of RRT ⩾80 years or even ⩾70 years in combination with severe comorbidities. However cancer itself does not seem to be a determining factor for short-term survival outcome and should not be used as argument alone to withhold RRT. Several prognostic tools can be implemented to identify elderly patients at high risk of functional decline and mortality after initiation of RRT. Advanced care planning focusses on timely discussions between patients, family members and practitioners about the patient’s desires and treatment goals which can help them avoid decisional conflict at the end- of-life and improve the quality of life. Keywords Dialysis, onco-nephrology, acute kidney injury Date received: 11 June 2020; accepted: 6 November 2020 1 Department of Nephrology, University Hospitals Leuven, Leuven, Belgium 2 Department of Nephrology, Jessa Hospital of Hasselt, Hasselt, Belgium 3 Faculty of Medicine and Life Sciences, University of Hasselt, Diepenbeek, Belgium 4 Department of Oncology, KU Leuven, Belgium 5 Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium 6 Onco-Nephrology Clinic, Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, ASST Santi Carlo e Paolo, Milan, Italy 7 Department of Microbiology and Immunology, Laboratory of Molecular Immunology (Rega Institute), KU Leuven, Belgium 8 Cancer-Kidney International Network (C-KIN), Brussels, Belgium Corresponding author: Ben Sprangers, Department of Nephrology, University Hospitals Leuven, Herestraat 49, Leuven, B-3000, Belgium. Email: ben.sprangers@uzleuven.be 976657JNP 0 0 10.1177/2399369320976657Journal of Onco-NephrologyVan der Veen et al. review-article 2020 Review