Incident maintenance dialysis patients have worse survival than patients with some common solid organ cancers, according to new Canadian study.
Among men, those on dialysis had a significantly worse unadjusted 5-year survival probability (50.8%) than men with prostate cancer (83.3%) and colorectal cancer (56.1%), but significantly better survival probabilities than those with lung cancer (14%) and pancreatic cancer (9.1%). Among women, those on dialysis had a significantly lower unadjusted 5-year survival probability (49.8%) than women with breast cancer (82.1%) and colorectal cancer (56.8%), but a significantly higher probability than those with lung cancer (19.7%) and pancreatic cancer (9.4%).
“These results highlight the need to develop interventions to improve survival on dialysis therapy and can be used to aid advance care planning for elderly patients beginning treatment with maintenance dialysis,” a team led by Gregory A. Knoll, MD, MSc, of the University of Ottawa and The Ottawa Hospital in Canada, reported in the American Journal of Kidney Diseases.
Using administrative databases, Dr Knoll and his colleagues compared with 33,500 incident maintenance dialysis patients in Ontario, Canada, and 532,452 incident patients with cancer (prostate, colorectal, lung, and pancreatic cancer in men and breast, colorectal, lung, and pancreatic in women).
The study found that women and men aged 70 years and older on maintenance dialysis had unadjusted 10-year survival probabilities comparable to those with lung and pancreatic cancers. Among men, those 10-year probabilities were 6.1%, 5.0%, and 3.1% for dialysis patients and those with lung and pancreatic cancers, respectively. Among women, those probabilities were 8.3%, 7.3%, and 3.1%, respectively.
With respect to study limitations, the authors pointed out that their findings might not be generalizable to other countries and races, noting that 75% of the Ontario population is of white race. In addition, the investigators lacked information on cancer stage for a large portion of the cancer patients, so they could not compare mortality among the dialysis patients with cancer patients by disease stage.
Naylor KL, Kim SJ, McArthur E, et al. Mortality in incidence maintenance dialysis patients versus incident solid organ cancers: A population-based cohort. Am J Kidney Dis. 2019; published online ahead of print.