IN THE NEWS: Tyrosine Kinase Inhibitors and CKD

A recent retrospective study in Annals of Oncology takes on the use of the tyrosine kinase inhibitors sunitinib and sorafenib in the CKD patients and even patients on dialysis.  Onco-Nephrology or the role of the nephrologists in the care of the cancer patients is becoming more and more important as most new chemo drugs are known to cause some degree of renal damage.
Tyrosine kinase inhibitors have anti VEGF effects and now have known to cause AKI, AIN, proteinuria, HTN and sometimes a pre eclampsia like syndrome as well.
Using them in CKD patients would scare me.  This study , although retrospective showed that with dose modifications, even patients on dialysis and CKD received it with no renal toxicity.  Perhaps dialysis removes some metabolite that might be reno toxic.
This is more and more important as nephrologist we might get scared of few cases in the literature causing injury but for that specific patient with cancer, these drugs might be those few months of quality of life and hope.
Having studies like these are important to stress that in the big scheme of things, these drugs still are good for treating Renal Cell Cancer and just because they have renal side effects, we should not avoid them. Rather, use them with caution and watch for changes in crt, HTN and proteinuria and monitor patients more closely.

Other key references:
http://www.ncbi.nlm.nih.gov/pubmed/20142724
http://www.ncbi.nlm.nih.gov/pubmed/19421832
http://www.ncbi.nlm.nih.gov/pubmed/18709027
http://www.ncbi.nlm.nih.gov/pubmed/19054798