Medical Advisory Board: Dr. Ram Dandillaya, Clinical Chief, Cardiology, Cedars-Sinai; Dr. Antonio J. Forte, Faculty, Mayo Clinic; Dr. John J. Lee, Faculty, Harvard Medical School; Dr. Daniel Kahneman, Nobel Prize Laureate. OpenEvidence is a Mayo Clinic Platform Accelerate Company.
Answered on June 5, 2023
The appropriate timing and dosage of Fluorouracil (5-FU) for a patient undergoing hemodialysis should be carefully considered due to the altered pharmacokinetics in these patients. In a case report of a patient with gastric cancer and chronic renal failure treated with 5-FU/leucovorin (LV) infusion chemotherapy, hyperammonemia was managed by adjusting the timing of hemodialysis.[1] Initially, the patient developed symptomatic hyperammonemia and underwent emergency hemodialysis on day 3. In subsequent cycles, the 5-FU dose was reduced, but hyperammonemia persisted, requiring hemodialysis on day 3. By changing the scheduled hemodialysis from day 3 to day 2, symptomatic hyperammonemia was prevented in cycles 5-7.[1]
Although there are no set recommendations for dose adjustment of 5-FU in the presence of renal or hepatic dysfunction, it is crucial to monitor patients closely for adverse events and adjust the treatment regimen accordingly.[2] In the case report mentioned above, the 5-FU dose was reduced, and the timing of hemodialysis was adjusted to manage hyperammonemia.[1] Further studies with more cases are needed to determine the optimal dosage and timing of hemodialysis for patients with impaired renal function receiving 5-FU treatment.


1.Ozaki Y, Imamaki H, Ikeda A, et al. Successful Management of Hyperammonemia With Hemodialysis on Day 2 During 5-Fluorouracil Treatment in a Patient With Gastric Cancer: A Case Report With 5-Fluorouracil Metabolite Analyses. Cancer Chemotherapy and Pharmacology. 2020;86(5):693-699. doi:10.1007/s00280-020-04158-1.
2.Diasio RB, Harris BE. Clinical Pharmacology of 5-Fluorouracil. Clinical Pharmacokinetics. 1989;16(4):215-37. doi:10.2165/00003088-198916040-00002.


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