Association of Dialysis with the Risks of Cancers
Open Access
- 13 April 2015
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 10 (4), e0122856
- https://doi.org/10.1371/journal.pone.0122856
Abstract
To increase the survival span after dialysis in patients with end-stage renal disease (ESRD), identifying specific cancer risks is crucial in the cancer screening of these patients. The aim of this study was to investigate the risks of various cancers in an incident dialysis group in comparison with a non-dialysis group. We conducted a nationwide cohort study by using data from the Taiwan National Health Insurance Research Database. Patients who initially received long-term dialysis between January 1997 and December 2004, were selected and defined as the dialysis group and were matched with the non-dialysis patients (control group) according to age, sex, and index year. Competing risk analysis was used to estimate cumulative incidence and subdistribution hazard ratios (SHRs) of the first cancer occurrence. After consideration for the competing risk of mortality, the dialysis group showed a significantly higher 7-year cancer incidence rate than did the control group (6.4%; 95% confidence interval [CI], 6.0%-6.7% vs 1.7%; 95% CI, 1.4%-2.1%; P .001).The modified Cox proportional hazard model revealed that the dialysis group had significantly association with increased risks for all cancers (SHR, 3.43; 95% CI, 3.02-3.88). The risk of cancers was dominated in younger and female patients. Specific cancer risks were significantly higher in the dialysis group particularly in the development of oral, colorectal, liver, blood, breast, renal, upper urinary tract, and bladder cancer than in the control group. Multivariable stratified analyses confirmed the association between long-term dialysis and cancer in all subgroups of patients. Dialysis is associated with a higher risk of cancer in patients with ESRD. However, cancer screening in ESRD population should be a selective approach, based on individual patient health condition and life expectancy.Keywords
This publication has 30 references indexed in Scilit:
- Risk of human papillomavirus-related cancers among kidney transplant recipients and patients receiving chronic dialysis - an observational cohort studyBMC Nephrology, 2013
- Sex Differences in the Development of Malignancies among End-Stage Renal Disease Patients: A Nationwide Population-Based Follow-Up Study in TaiwanPLOS ONE, 2012
- Cancer risk among elderly persons with end-stage renal disease: a population-based case–control studyBMC Nephrology, 2012
- Aristolochic acid-associated urothelial cancer in TaiwanProceedings of the National Academy of Sciences of the United States of America, 2012
- Association of Hepatitis C and B Virus Infection With CKD in an Endemic Area in Taiwan: A Cross-sectional StudyAmerican Journal of Kidney Diseases, 2010
- Population-Based Case-Control Study of Chinese Herbal Products Containing Aristolochic Acid and Urinary Tract Cancer RiskJNCI Journal of the National Cancer Institute, 2009
- Increased Mortality Risk for Cancers of the Kidney and Other Urinary Organs among Chinese HerbalistsJournal of Epidemiology, 2009
- Aspects of Immune Dysfunction in End-stage Renal DiseaseClinical Journal of the American Society of Nephrology, 2008
- A Proportional Hazards Model for the Subdistribution of a Competing RiskJournal of the American Statistical Association, 1999
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databasesJournal of Clinical Epidemiology, 1992