Cancer Incidence and Mortality in Chronic Dialysis Population: A Multicenter Cohort Study

Abstract

Background: Different studies in the past have shown that the risk of cancer development is increased in chronic dialysis patients. However, data concerning the cancer risk in Asian dialysis patients was scarce. More importantly, there was lack of information about the cancer-specific mortality in dialysis patients. Methods: A multicenter retrospective cohort study of 6,254 patients who started either chronic peritoneal dialysis or hemodialysis between 1994 and 2014 in 4 renal units in Hong Kong. Patterns of cancer incidence and mortality in our dialysis patients were compared with those of the general population using standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) respectively. Results: With 14,887 person-years of follow-up, 220 cancers were recorded. The SIR of all cancers was 1.44 (95% CI 1.26-1.65). A trend of an increased SIR was observed in young patients and within the first year of dialysis. Colorectum was the most common site of cancer (20%) while kidney cancer carried the highest risk (SIR 12.28, 95% CI 8.44-17.08). The SMR of all cancers was 0.91 (95% CI 0.72-1.13) and only kidney cancer had higher cancer mortality risk (SMR 4.92, 95% CI 1.80-10.70). SMR was highest in young patients and then decreased with age. Conclusions: The incidence of cancers in our chronic dialysis patients was elevated. Our findings of substantially increased risks in young patients, particularly in relation to kidney cancer, suggest that we can adopt a more individualized approach to cancer screening in chronic dialysis patients.

Association of TSH Elevation with All-Cause Mortality in Elderly Patients with Chronic Kidney Disease

“…A more recent study in the US found that CVDs and cancer were the leading causes of death in CKD patients, with more cancer deaths than CVD deaths in patients in the earlier stages of kidney disease [36]. Similarly, a recent study in Hong Kong reported a higher incidence of cancer in chronic dialysis patients compared with the age- and sex-matched general population [38]. …”

“…Patients on chronic dialysis may have impaired immune function, decreased antioxidant defense, accumulation of carcinogenic substances, and chronic infections and inflammation, suggesting that CKD patients may have a higher risk of cancer [35]. Consistent with this idea, an increased incidence of cancer has been observed in non-dialysis CKD patients [36] and chronic dialysis patients [37,38]. However, few studies have assessed the relationship between abnormally low thyroid function and mortality in elderly patients with CKD.…”

The effect of chronic kidney disease on T cell alloimmunity

“…Patients with end-stage renal disease (ESRD), at the extreme end of the CKD spectrum, have long been recognized to have signs of immune dysfunction evidenced by increased susceptibility to infections [1,2], increased risk of cancer [1,3], and impaired response to vaccination [4,5]. It has become increasingly recognized that CKD results in impaired interaction between the innate and adaptive arms of the immune system [6].…”

Obesity, Diabetes Mellitus, Hypertension and other Risk Factors for Renal Cell Carcinoma in Japan: A Mini-Review

“…In East Asia, Cheung et al [34] reported that chronic dialysis patients showed a significantly higher incidence and mortality of kidney cancer than general population in Hong Kong while Chien et al [35] found that dialysis patients increased the risk of dying from kidney cancer compared to the general population in Taiwan. In Japan, Satoh et al [11] reported that 38 (0.6%) out of 6201 dialysis patients [12] reported that 44 patients (1.7%) were pathologically diagnosed with renal cell carcinoma in 2,624 dialysis patients between 1993 and 2004.…”