Higher Cancer Risk in Dialysis Patients Confirmed

The risk is most elevated among individuals aged 44 years or younger.
The risk is most elevated among individuals aged 44 years or younger.

Chinese patients on chronic dialysis, especially younger individuals, have an increased incidence of cancer compared with the age- and sex-matched general population, according to a new study.

Chi Yuen Cheung, MD, of Queen Elizabeth Hospital in Hong Kong, and colleagues retrospectively studied 6,254 patients who started either chronic hemodialysis or peritoneal dialysis from 1994 to 2014. During 14,887 person-years of follow-up, 220 patients (3.5%) were diagnosed with cancer. Overall, the cohort had a 44% higher risk of any cancer compared with the age- and sex-matched general population, the investigators reported in the American Journal of Nephrology (2016;43:153-159). The risk was highest among younger patients and decreased with age. Patients aged 44 years or younger and 45–64 years had a 40 times and 3.4 times increased risk, respectively, whereas those aged 65 years and older had a 19% decreased risk. Cancer risk was highest within the first year of dialysis.

Among the various cancers examined in the study, the risk was most elevated for kidney cancer, particularly in younger patients. The risk of kidney cancer was 12 times higher than in the age-and sex-matched general population for the entire cohort, but 550 times higher among patients aged 44 years or younger. The lowest observed cancer risk was for prostate cancer, which was 73% lower for the dialysis patients versus the general population.

During follow-up, 160 cancer patients (72.7%) died. The cancer mortality risk was similar in the dialysis patients and the general population, Dr. Cheung's group reported.

The authors noted that the cancer incidence observed in their study cohort was similar to that found in studies conducted in the United States, Australia, and Europe.

Regarding the markedly lower risk of PCa in their cohort, the researchers explained that men with end-stage renal disease, as a result of their decreased life expectancy, may receive PSA screening less frequently than other men, leading to an apparent lower incidence of PCa.

Dr Cheung and colleagues concluded that their “findings of substantially increased risks in younger patients, particularly in relation to kidney cancer, indicate we can adopt a more individualized approach to cancer screening in chronic dialysis patients.”

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