Patients on dialysis are twice as likely to die from cancer than the general population
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Patients using dialysis die from cancer at twice the rate as individuals of the same age and sex in the general population, according to data published in the American Journal of Kidney Diseases.
“Cancer survival is improving in the general population because of improved screening and treatments, but it is unclear if people with kidney failure receiving dialysis, who are more likely to develop cancer, have also benefitted from these trends,” Brenda M. Rosales, MPH, PhD, a faculty of medicine and health in the Sydney School of Public Health at the University of Sydney in Australia, and colleagues wrote. “Here we use a bi-national linked population-based dataset to estimate cancer mortality rates for people on dialysis for kidney failure, relative to the general population, and describe trends over time and by age, sex and treatment modality.”
In a retrospective cohort study, researchers explored cancer mortality in 59,648 patients on dialysis in the Australian and New Zealand Dialysis and Transplantation Registry between 1980 and 2013. The Australian Institute of Health and Welfare and the New Zealand Ministry of Health provided causes of death and data on those in the general population.
Researchers compared rates of cancer death among patients on dialysis with people in the general population of their same age and sex. Using indirect standardization on age at death, sex, year and country, researchers estimated standardized mortality ratios.
During 269,598 person-years of observation, 34,100 deaths occurred including 3,677 cancer deaths. Researchers determined the relative risk of all-site cancer death among patient on dialysis was twice that of individuals in the general population. Specifically, patients on dialysis were at the highest risk of mortality caused by oral and pharynx cancers and multiple myeloma.
Compared with men, women were at a higher risk for all-site cancer mortality, and those using hemodialysis experienced greater all-site cancer deaths than those using peritoneal dialysis. Although excess deaths have decreased over time for those on dialysis, trends have not kept up with improvements among the general population, according to researchers.
“In conclusion, our findings demonstrate that all-site cancer mortality in people on dialysis remains in excess of the general population. Cancer mortality differs by age and sex and the relative risk of death is increasing for cancers common in the general population,” Rosales and colleagues wrote. “Understanding the role of kidney failure and other multimorbidity in the prevention and treatment of cancer is critically important for shared decision-making and the redress any inequities in outcomes.”
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