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Younger adults on dialysis at increased risk of malignancies, cancer screening necessary
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According to a published study, young Taiwanese adults who received maintenance hemodialysis had a higher cumulative risk of malignancy than older adults. Researchers suggested that this finding calls for specialized cancer screening protocols and prevention strategies.
“It has been reported that the prevalence rates of genitourinary malignancies, liver cancer, thyroid cancer, multiple myeloma and lymphoma are higher in ESRD patients compared to the general population,” Heng-Chih Pan, MD, of Keelung Chang Gung Memorial Hospital and Chang Gung University in Taiwan, and colleagues wrote. “Previous studies have reported that the risk of malignancies in patients with ESRD decreases with advancing age. However, most previous studies have been limited by including patients with ESRD who were and were not receiving maintenance dialysis, and a lack of information on personal habits. These limitations may have skewed the results due to confounding caused by the unadjusted underlying risk factors and competing risk of mortality.”
Noting there is also a “positive correlation between the length of [hemodialysis] HD and onset of malignancies,” researchers analyzed data from a nationwide cohort database to study malignancies in 3,055 patients who had recently initiated dialysis, specifically considering the incident rate according to age. Each patient was matched to four controls who did not have ESRD and who were not on dialysis.
Results showed the incidence rates of malignancy were 6.8% in the hemodialysis group vs. 4.9% in the control group, with patients aged younger than 70 years having significantly greater incidence. After adjusting for a variety of factors (including age, gender and diabetes), researchers found receiving hemodialysis was an independent prognostic indicator of malignancy, especially for younger patients (odds ratios of developing cancer = 5.8, 1.9, 1.9 and 1.5 for patients aged <40 years, 40 to 49, 50 to 59 and 60 to 69, respectively). Male gender, diabetes and hypertension were also independent risk factors for malignancy development.
Researchers contended that diagnosing patients on hemodialysis who might develop malignancies is difficult for clinicians due to lack of obvious symptoms. In addition, general routine cancer screening is often not recommended for these patients because it is not seen as cost-effective when life expectancy is shorter than the time required to develop malignancy.
However, they wrote, “In Taiwan, [hemodialysis] HD patients younger than 60 years old have an average life expectancy of more than 10 years, and our study highlights the signicantly high incidence of cancer, particularly of genitourinary organs, liver and lymphatic and hematopoietic malignancies in these patients ... Routine screening for genitourinary and liver malignancies may therefore be benecial for young HD patients.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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