Revious case studies have examined different doses and intervals between HD and drug administration. HD immediately after dialyzable drug administration may improve tolerance although such protocols may lead to the reduction of anti-neoplastic efficacy and impose excess burden on the patient and treatment teams. In addition, a limited number of facilities can offer both HD and anti-cancer treatment on the same day. These limitations might deprive the patient of opportunities to receive optimal anti-cancer treatment. These social factors must also be taken into consideration in the establishment of anti-cancer therapeutic protocols. This section focuses on the relatively well-described anti-cancer agents used in HD patients that have different main elimination organs, carboplatin (mainly eliminated by the kidney) and 5-fluorouracil (5-FU) (mainly eliminated by the liver), as well as tyrosine kinase inhibitors, that are frequently used in this new era of targeted anti-cancer therapy.Carboplatincarboplatin influences the concentration of carboplatin in the plasma, since carboplatin can be removed from the plasma by HD [48]. The interval between the administration of carboplatin and HD varied between 1 and 24 h in previous studies (Table 3). In these studies, the AUCs varied depending on the doses and intervals between drug infusion and HD. Although there were variations between studies, the AUCs seemed to be higher when HD was started long after carboplatin infusion. A certain amount of carboplatin can be eliminated by performing HD in an early phase when the protein binding ratio is low [54]. This dialyzability may help to improve tolerance, although actual AUC values may be less reliable and more unstable when HD is performed immediately after the administration [51]. The protein binding of carboplatin, which hinders its elimination in HD, has been observed to increase by 50 after 24 h of administration [54]. Oguri et al. reported that the actual AUC values were approximately 20 higher than the target AUC when HD was performed 24 h after the administration of carboplatin [51]. Particular attention should be paid to the development of adverse events such as hematological toxicities when there is a long interval between carboplatin administration and HD.5-FUOne of the most widely used anti-cancer agents in HD patients is a platinum derivative, carboplatin [48, 49]. In patients with normal renal function, approximately 70 of the administered dose is excreted in the urine [50]. It has been shown that the target area undCapivasertibCapivasertib Abstract(s)">PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/6833145 and cytotoxic effects. Therefore, in clinical practice, the Calvert formula is well accepted for calculating the dose of carboplatin: dose (mg) = AUC (mg/ml ?min) ?(glomerular filtration rate [GFR] (ml/min) + 25) [50]. For patients with ESRD, many clinicians still use this formula with the assumption that the GFR can be almost equal to zero [51?3]. This AUC-targeted dose adjustment has permitted the individualization of the carboplatin dose for maximum effect with tolerable adverse effects. The HD setting after the administration of5-FU is mainly metabolized via redihydropyrimidine dehydrogenase in the liver and other tissues, and only a small amount of 5-FU (approximately 10 of the administered dose) is eliminated unchanged by the kidney [55]. In line with its short elimination half-life (20 min), 5-FU is given by intravenous continuous infusion ove.