CONSULT ROUNDS: Tumor lysis syndrome 2

What dialysis modality is the best for TLS?

On one hand you can have severe hyperkalemia that might require urgent hemodialysis and on other hand there is constant catabolic turnover that might require a continuous modality.

1. Treat the life threatening electrolyte disorder first namely hyperkalemia and might need few hours of HD followed by continuous form of dialysis (CVVH, CVVHD, CVVHDF) to prevent rebound hyperkalemia and combat the catabolic breakdown.

2. The phosphate clearance might be best achieved via a continuous modality in such cases.  High dialysate flows might be necessary.

3. Peritoneal dialysis is usually not recommended mainly because it cannot clear uric acid well.