Maintenance hemodialysis patients have high cumulative radiation exposure

Abstract

Hemodialysis is associated with an increased risk of neoplasms which may result, at least in part, from exposure to ionizing radiation associated with frequent radiographic procedures. In order to estimate the average radiation exposure of those on hemodialysis, we conducted a retrospective study of 100 patients in a university-based dialysis unit followed for a median of 3.4 years. The number and type of radiological procedures were obtained from a central radiology database, and the cumulative effective radiation dose was calculated using standardized, procedure-specific radiation levels. The median annual radiation dose was 6.9 millisieverts (mSv) per patient-year. However, 14 patients had an annual cumulative effective radiation dose over 20 mSv, the upper averaged annual limit for occupational exposure. The median total cumulative effective radiation dose per patient over the study period was 21.7 mSv, in which 13 patients had a total cumulative effective radiation dose over 75 mSv, a value reported to be associated with a 7% increased risk of cancer-related mortality. Two-thirds of the total cumulative effective radiation dose was due to CT scanning. The average radiation exposure was significantly associated with the cause of end-stage renal disease, history of ischemic heart disease, transplant waitlist status, number of in-patient hospital days over follow-up, and death during the study period. These results highlight the substantial exposure to ionizing radiation in hemodialysis patients.

Estimated Radiation Exposure from Medical Imaging in Hemodialysis Patients

“…28 To our knowledge, there is only one published study on the CEDs that maintenance hemodialysis patients accrue over time. 5 Notwithstanding a shorter period of follow-up (281 patientyears) in our study compared with the one reported by Kinsella et al (345 patientyears) and a lower number of total radiologic procedures registered (1303 in our study versus 2575 reported by Kinsella et al), the median estimated total CED was higher (27.3 versus 21.7 mSv), and even more relevant, the median annual CED was almost doubled in our study (11.7 versus 6.9 mSv). This is mainly because of the severe underestimation in the study of Kinsella et al of the contribution of CT exposure.…”

“…Chen et al 26 reported a mean total CED over 3 years of 23.1 mSv for 90,121 patients who underwent more than one cardiac imaging procedure. These values must be compared with our estimate of mean total CED over 3 years of 55.7 mSv in 106 dialysis patient or to the corresponding estimate of 34.2 mSv reported by Kinsella et al 5 in 100 dialysis patient for a median of 3.4 years of follow-up.…”

“…4 Patients on hemodialysis require ongoing care that often results in repeated imaging and repeated exposure to ionizing radiation for both diagnostic and therapeutic purposes. 5 Maintenance hemodialysis, besides being such a chronic condition, is associated with an increased incidence of cancer of unclear etiology. Patients with ESRD have a fourfold higher risk of cancer compared with the general population, but the cancer risk is different according to the renal replacement therapy: there is an increase of 1 to 1.5 times during dialysis and 2.5 to 5 times after kidney transplantation for both uremia and drug-related immunosuppression.…”

Renal Cell Carcinoma and Mucinous Adenocarcinoma of Ureter after Renal Transplantation with Neoplasm of Urethra in Follow up

“…[2][3][4] According to Suson et al, 9 the cure rate for transplant patients with localized disease who undergo nephrectomy is high, with disease-related mortality being from 0-10%. Thus, screening practices should prioritize the identification of high-risk patients, since the removal of the tumor in the native organ is potentially curative.…”

“…Factors such as being male, recipient and donor age, recipient of African descent, prolonged dialysis, immunosuppressant therapy and acute post-transplant rejection are related to risk for RCC after renal transplant. [2][3][4] This paper presents the first case of a renal transplant patient with double malignancy of the upper urinary system and cancer of the urethra evident after four years of follow-up.…”