Patients with end-stage renal disease (ESRD) receiving hemodialysis have an added burden: high rates of cancer, according to a new study.

Anne M. Butler, PhD, and colleagues from the University of North Carolina at Chapel Hill calculated cancer incidence rates for almost a half million adults in Medicare’s ESRD program who received dialysis therapy between 1996 and 2009.

According to results published online ahead of print in the American Journal of Kidney Diseases, the investigators observed a constant rate of cancers in patients, from 3,923 to 3,860 cases per 100,000 persons per year. Over 13 years, the rate of kidney cancer rose, while the rates of other cancers, such as colon and lung, declined.

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The 5-year cumulative incidence of any cancer was 9.48%, much higher than the incidence that would be expected in the general population. The risk for kidney cancer was 4 times higher and bladder cancer was 1.5 times higher.

“These results suggest that patients with ESRD are uniquely at risk for developing cancer while receiving hemodialysis treatment,” the researchers stated.

Cancer incidence was higher for certain patients: seniors, men, non-Caucasian and non-Hispanic ethnicities, people without diabetes, new dialysis patients, and transplant candidates.

The investigators suggest several possible explanations for the higher cancer rates among dialysis patients, including ESRD-associated immunodeficiency and nutritional abnormalities. In addition, uremic and dialysis-induced immune dysfunction may interact with cancer risk factors such as tobacco.

“Our findings of differential cancer incidence among certain subgroups highlight the need to potentially reevaluate target cancer screening practices. Furthermore, targeted screening for certain cancer types should be considered,” the researchers stated. 


  1. Butler, AM, et al. AJKD; doi: 10.1053/j.ajkd.2014.12.013.