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Patients with ESKD are at increased risk for cancer-related mortality
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Patients with ESKD who were on dialysis or had a kidney transplant were 2.5-times more likely to experience cancer-related mortality than the general population, according to a study published in the Journal of the American Society of Nephrology.
“The results from this study will assist clinicians and researchers in understanding the patterns of cancer-related mortality in patients on dialysis and patients after kidney transplantation,” Eric H. Au, MBBS, a PhD research student at the Sydney School of Public Health at the University of Sydney and the Centre for Kidney Research, told Healio/Nephrology. “We need to find better ways of identifying people at risk of cancer and cancer death in this population in addition to managing their kidney disease, and better treatment strategies for patients with end-stage kidney disease who develop cancer.”
To assess the pattern of cancer mortality in patients on dialysis and after kidney transplantation, researchers used the Australia and New Zealand Dialysis and Transplant Registry to identify Australian patients with ESKD who were on dialysis (n = 52,936; median age, 60 years) or had a transplant (n = 16,820; median age, 43 years) from 1980 through 2014. Patients who were on dialysis and later received a kidney transplant were included in the dialysis group until the time of transplantation.
Researchers then matched participants by age and sex to the general population and compared cancer mortality using standardized mortality ratios.
Patients on dialysis were followed for a median of 2.3 years, while patients who had a kidney transplant were followed for a median of 6.3 years. During this time, 26,004 and 3,168 cancer-related deaths occurred in the dialysis (median age of death, 70 years) and transplant (median age of death, 62 years) cohorts, respectively.
Of the total deaths, 2,739 were attributable to cancer for patients on dialysis (standardized mortality ratio = 2.6), with 923 being cancer-related for patients who had a kidney transplant (standardized mortality ratio = 2.7).
Researchers also found that, for patients on dialysis, standardized mortality ratios were highest for those with multiple myeloma (30.5), testicular cancer (17) and kidney cancer (12.5). For transplant recipients, standardized mortality ratios were highest among those with non-Hodgkin lymphoma (10.7), kidney cancers (7.8) and melanoma (5.8).
In addition, it was observed that the increased risk for cancer-related mortality was mostly due to pre-existing cancer for patients on dialysis (61% of patients on dialysis had pre-existing cancer vs. 9.6% of patients with kidney transplant). For transplant recipients, the increased risk stemmed mainly from cancers that developed after transplantation, particularly cancers relating to immunosuppression such as post-transplant lymphoproliferative disorder and non-Hodgkin lymphoma, according to Au.
“Women and younger patients also experienced particularly high risks of cancer death compared with the general population,” Au added.
“Further research is needed to explore the risk factors and mechanisms which contribute to the higher rates of cancer mortality in patients on dialysis and patients with kidney transplants.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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