Cancer mortality rates are higher among the dialysis population than the general population, a new Australian study finds.
Among 59,648 patients on dialysis in the 1980-2013 Australian and New Zealand Dialysis and Transplantation Registry, 34,100 died, including 3677 from cancer.
The risk for cancer mortality in the dialysis population was 2.4-fold higher than expected in the general population, Brenda M. Rosales, MPH, PhD, of The University of Sydney, Sydney, New South Wales and colleagues reported in the American Journal of Kidney Diseases. By cancer site, the excess death risk among patients on dialysis was 24-, 22-, 17-, and 14-fold higher among those with oral and pharynx cancers, multiple myeloma, lymphoma, and kidney cancer, respectively.
Women on dialysis had significantly greater excess death risk from any cancer compared with men on dialysis: 2.7-fold vs 2.3-fold higher risk compared with the sex-matched general population. Patients receiving hemodialysis had greater excess death risk from any cancer than patients on peritoneal dialysis (2.2-fold vs 1.3-fold higher risk compared with the general population). Excess death risk was highest among patients initiating dialysis at age 35 years or younger.
Excess deaths have significantly declined over the last 40 years for cancer overall, multiple myeloma, and kidney cancers, but more so in the general than dialysis population, the investigators reported. Among patients on dialysis, excess deaths significantly increased for colorectal and lung cancers.
The investigators noted that patients on dialysis often have multiple comorbidities and increased frailty at younger ages. Whether clinicians are delivering optimal cancer therapies to these patients is an open question.
“Understanding the role of kidney failure and other multimorbidity in the prevention and treatment of cancer is critically important for shared decision making and the redress [of] any inequities in outcomes,” according to Dr Rosales’ team.
Rosales BM, De La Mata N, Vajdic CM, Kelly PJ, Wyburn K, Webster AC. Cancer mortality in people receiving dialysis for kidney failure: An Australian and New Zealand cohort study, 1980-2013. Am J Kidney Dis. 2022 Apr 29;S0272-6386(22)00624-2. doi:10.1053/j.ajkd.2022.03.010