How does dialysis impact treatment?

How does dialysis impact treatment? So really complicated question. Nowadays, we let the kidney function deteriorate quite a long time before we put them on dialysis. In general, we wait to get down to around 5% kidney function in that ballpark. There are only a handful of acute indications for dialysis, so it's really important to work not only with your oncologic care team, but to work with a nephrologist as well, because there's actually been studies that anyone who has any kidney disease, even if it's mild, you live longer and do better if you follow with a nephrologist, a kidney doctor. Most people in the world who end up on dialysis never come off. Some myeloma patients who present with kidney dysfunction who go on dialysis early on have the possibility of coming off. The longer you remain on dialysis, the harder it is to get off of it. The longest patient I've ever had on it was on for 18 months, but eventually came off. So for the most part, we try to give treatment right after dialysis. However, this can become complicated as most patients on regular dialysis are on three times a week, either Monday, Wednesday, Friday, or Tuesday, Thursday, Saturday. So depending upon if you're getting once a week treatment or twice a week or every other You have to work with your care team to figure out what's going to be best, maximizing drug clearance as well as lifestyle, because you want to try to avoid spending every single day of the week in a doctor's office. Are there different types of dialysis? The two main types are what we call hemodialysis and peritoneal dialysis. Hemodialysis is where we have some access to the patient's blood through a catheter, and we process that blood through a dialysis machine and clear out the bad stuff and put the blood back in. The other type is called peritoneal dialysis, where patients have a little catheter in their belly called a tank off, and you'd put in some fluid there and through kind of complex mechanisms and different exchange of chemicals, that fluid then comes back out and it brings out some of the toxins with it. And that type of dialysis can actually be done at home by patients. So it's really important to work with your care team as far as which one may be better, but they're definitely both options. How does dialysis affect treatment? It turns out that for the majority of myeloma therapies that we currently have available, being on dialysis will not prohibit the use of any of them. Some drugs will need to be dose adjusted because they're cleared out of the body by the kidneys. So one of the big drugs we use is a drug called Revlimid. If you're on dialysis, we have to lower the dose of Revlimid so you don't have any bad side effects of lowered blood counts from not clearing out the drug fast enough. But many other drugs like Darzalex and Velcade can be given at full dose even if you're on dialysis.