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Effectively by HD due to the relatively high molecular weight, serum levels are elevated after HD as a result of hemoconcentration, limiting their clinical effectiveness [31?3]. Total PSA, the sum of free and complex PSA, is used as a screening test for prostate cancer, usually in combination with digital rectal and ultrasound-guided examination. The percent of free PSA (fPSA) in total PSA (tPSA) is also used to enhance the discrimination of prostate cancer because the percent of fPSA is lower in men with prostate cancer than that in men with benign disorders [34]. tPSA is valid in dialysis patients, although fPSA is elevated and should not be used as a screening test for prostate cancer in dialysis patients [35]. Cancer antigen 125 (CA125) is a tumor marker for ovarian cancer but is also produced by mesothelial cells [36]. Serum CA-125 levels are elevated in HD patients with serosal fluid, pleural effusion, ascites, etc., and the results should be interpreted with caution [37]. In particular, this marker is a lessKitai et al. Renal Replacement Therapy (2016) 2:Page 4 ofTable 2 Summary of tumor markers in dialysis patients (modified from [31])Tumor marker (A) Reliable in dialysis patients Total prostate-specific antigen (tPSA) Free PSA (fPSA) could be filtered through glomeruli, consistent with its low molecular weight (28 kDa). Decreased GFR leads to an increased serum level of fPSA and higher percent fPSA to tPSA ( fPSA), since the level of tPSA does not differ compared with that of the controls [35]. Although not eliminated by low-flux membranes, fPSA is cleared by high-flux membranes [76], since molecules smaller than 5 and 50 kDa are filtered by lowflux and high-flux dialysis membranes, respectively [39]. Comments-human chorionic gonadotropin (-hCG), -fetoprotein (B) Falsely elevated in dialysis patients Cancer antigen 125 (CA-125) CA-125 is elevated in patients with peritoneal, pleural, or pericardial effusion [37]. Gemcitabine (hydrochloride) In particular, CA-125 is falsely elevated as a result of nonspecific peritoneal irritation or peritonitis in patients undergoing peritoneal dialysis [38]. The serum concentration of CA-125 is increased during hemodialysis, probably due to hemoconcentration [32]. Although the metabolism and clearance are not fully understood, previous studies revealed that the PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/10389946 serum levels of CA19-9, CEA, SCC, and NSE are elevated in dialysis patients compared with patients with normal renal function [39?2]. An increase in the serum levels of these tumor markers is also found during hemodialysis, probably as a result of hemoconcentration [32]. It should be noted that SCC is cleared by high-flux membranes due to its molecular weight of 42 to 48 kDa, although it is not eliminated by low-flux membranes [33].Carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA), squamous cell carcinoma (SCC) antigen, and neuron-specific enolase (NSE)GFR glomerular filtration rateaccurate indicator of disease burden in patients undergoing peritoneal dialysis, since serum levels may be falsely elevated as a result of nonspecific peritoneal irritation or peritonitis [38]. Carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA), squamous cell carcinoma (SCC) antigen, and neuron-specific enolase (NSE) have also been reported to be falsely elevated in dialysis patients compared with patients with normal renal function [39?2]. In contrast, -fetoprotein and -human chorionic gonadotropin are reliable tumor markers in dialysis patients [43].