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. 2015 Apr 13;10(4):e0122856.
doi: 10.1371/journal.pone.0122856. eCollection 2015.

Association of dialysis with the risks of cancers

Ming Yen Lin  1 , Mei Chuan Kuo  2 , Chi Chih Hung  2 , Wen Jeng Wu  3 , Li Tzong Chen  4 , Ming Lung Yu  5 , Chih-Cheng Hsu  6 , Chien-Hung Lee  7 , Hung-Chun Chen  2 , Shang-Jyh Hwang  8
Affiliations

Association of dialysis with the risks of cancers

Ming Yen Lin et al. PLoS One. .

Abstract

Background: 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.

Method: 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.

Results: 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 <0.001).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.

Conclusions: 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.

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Conflict of interest statement

Competing Interests: Co-authors Ming-Lung Yu, Li-Tzong Chen, and Shang-Jyh Hwang are PLOS ONE Editorial Board members. This does not alter the authors’ adherence to PLOS ONE editorial policies and criteria.

Figures

Fig 1
Fig 1. Flow diagram illustrating the selection of patients and controls.
Fig 2
Fig 2. Cumulative incidence for cancer and mortality.
Data were compiled after consideration for competing mortality. The cumulative rate between dialysis and control group were calculated using Modified Kaplan-Meier and Gray methods [30] and test their difference between groups by modified log-rank test. The Modified log-rank P value for comparing the cumulative incidence for cancer in dialysis and control group is less than 0.001.
Fig 3
Fig 3. Multivariable stratified analyses for the association between dialysis and cancer.
Abbreviation: SHR, subdistribution hazard ratio; CI, confident interval.
See this image and copyright information in PMC

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