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.