Cancer Incidence Among US Medicare ESRD Patients Receiving Hemodialysis, 1996-2009

Abstract

Background Patients with end-stage renal disease (ESRD) receiving dialysis have been reported to have increased risk of cancer. However, contemporary cancer burden estimates in this population are sparse and do not account for the high competing risk of death characteristic of dialysis patients. Study Design Retrospective cohort study. Setting & Participants US adult patients enrolled in Medicare's ESRD program who received in-center hemodialysis. Factors Demographic/clinical characteristics. Outcomes For overall and site-specific cancers identified using claims-based definitions, we calculated annual incidence rates (1996-2009). We estimated 5-year cumulative incidence since dialysis therapy initiation using competing-risk methods. Results We observed a constant rate of incident cancers for all sites combined, from 3,923 to 3,860 cases per 100,000 person-years (annual percentage change, 0.1; 95% CI, −0.4 to 0.6). Rates for some common site-specific cancers increased (ie, kidney/renal pelvis) and decreased (ie, colon/rectum, lung/bronchus, pancreas, and other sites). Of 482,510 incident hemodialysis patients, cancer was diagnosed in 37,128 within 5 years after dialysis therapy initiation. The 5-year cumulative incidence of any cancer was 9.48% (95% CI, 9.39%-9.57%) and was higher for certain subgroups: older age, males, nonwhites, non-Hispanics, nondiabetes primary ESRD cause, recent dialysis therapy initiation, and history of transplantation evaluation. Among blacks and whites, we observed 35,767 cases compared with 25,194 expected cases if the study population had experienced rates observed in the US general population (standardized incidence ratio [SIR], 1.42; 95% CI, 1.41-1.43). Risk was most elevated for cancers of the kidney/renal pelvis (SIR, 4.03; 95% CI, 3.88-4.19) and bladder (SIR, 1.57; 95% CI, 1.51-1.64). Limitations Claims-based cancer definitions have not been validated in the ESRD population. Information for cancer risk factors was not available in our data source. Conclusions These results suggest a high burden of cancer in the dialysis population compared to the US general population, with varying patterns of cancer incidence in subgroups.

Cancer risk in patients receiving renal replacement therapy: A meta-analysis of cohort studies

“…Of these, 39 were excluded, as they comprised 3 duplicate studies, 2 studies not written in English, 1 review, 21 from which the SIR and 95% CI could not be calculated, 10 studies on hospital-based cohorts and 2 on irrelevant topics. Finally, 22 cohort studies contained in 18 studies were included in the present meta-analysis (8)(9)(10)(11)(12)(13)(14)(15)(16)(22)(23)(24)(25)(26)(27)(28)(29)(30). The main characteristics of the studies included are presented in Table I.…”

“…The main characteristics of the studies included are presented in Table I. The earliest study began in 1989 (22) and the latest ended in 2015 (11). All the studies were population-based.…”

“…In the past few years, several studies using registry data have provided convincing evidence for the increased incidence of certain cancer types in patients receiving RRT (4,(8)(9)(10)(11)(12)(13)(14)(15)(16). However, it remains to be determined whether meta-analysis of these studies and others may provide results that are different from those of previous meta-analyses.…”

De novo papillary carcinoma in a renal allograft: the pros and cons of immunosuppression

“…The overall incidence of malignancy in the dialysis population is already higher when compared to the general population [2]. Moreover, malignancy in the post-transplantation period is considered to be even higher when compared to the dialysis population particularly in the second and third decades post-transplant [3,4] (in this case, the patient presented 16 years after transplantation).…”

“…Cyclosporine (CyA) has been linked with increased risk of malignancy mostly in studies analysing its use in dermatological conditions [19,20]. On the other hand, Tacrolimus-based immunosuppression has been associated with a higher incidence of malignancy and shorter time interval between transplantation and tumour detection [2,21]. Fuchs et al found no difference in the oncogenic potential between Tacrolimus and Cyclosporine [22].…”