Higher risk of malignant neoplasms in young adults with end-stage renal disease receiving haemodialysis: A nationwide population-based study

Abstract

Aim: Previous investigations have shown that end-stage renal disease (ESRD) is associated with an increased risk of malignancies. The aim of this study was to explore the association between ESRD in patients undergoing maintenance haemodialysis (HD) and the incidence of malignancies according to age.

Methods: We analysed a nationwide cohort retrieved from Taiwan's National Health Insurance Research Database to study the incidence of malignancies in patients who were and were not receiving HD. One million beneficiaries were randomly selected and followed from 2005 to 2013. Of these 1 000 000 patients, 3055 developed ESRD and commenced maintenance HD during this period. For each HD patient, four age-, gender- and diabetes-matched controls were selected from the database (n = 12 220). We further stratified the patients according to age. The study endpoint was the occurrence of malignancy.

Results: The incidence rates of malignancy were 6.8% and 4.9% in the HD and control groups, respectively. Competing risk regression analysis indicated that age, HD, male gender and diabetes were associated with an increased risk of malignancy. When further stratified according to age, the odds ratios of developing cancer were 5.8, 1.9, 1.9 and 1.5 among the HD patients aged <40 years, 40-49 years, 50-59 years and 60-69 years, respectively.

Conclusion: The patients with ESRD who received HD had a significantly higher cumulative risk of malignancy, especially those with a young age. Therefore, specialized cancer screening protocols for young HD patients might help to prolong their lifespan.

Keywords: end-stage renal disease; haemodialysis; malignancy; young adults.

Figure 1

Flowchart of study enrolment. From 2005 to 2013, a total of 3055 patients from 1 million subjects in the NHIRD developed ESRD and received regular HD. For each HD patient, four age‐, gender‐ and diabetes‐matched controls (n = 12 220 patients) were selected from the NHIRD on the same date as the HD patients were enrolled. ESRD, end‐stage renal disease; HD, haemodialysis; LHID, Longitudinal Health Insurance Database; NHIRD, National Health Insurance Research Database.

Figure 2

Cumulative incidence rates of cancer in the 3055 HD patients and 12 220 controls. Patients were stratified according to age. The cumulative incidence curves illustrated that the HD patients had a higher risk of malignancy than the controls in the same age group, and especially the younger patients. HD, haemodialysis. () HD 00∼39, () HD 40∼49, () HD 50∼59, () HD 60∼69, () HD 70∼79, () HD 80up, () non HD 00∼39, () non HD 40∼49, () non HD 50∼59, () non HD 60∼69, () non HD 70∼79, () non HD 80up.