J Korean Med Sci.  2009 Jan;24(Suppl 1):S95-S101. 10.3346/jkms.2009.24.S1.S95.

Cancer in Patients on Chronic Dialysis in Korea

• Lee JE
• Han SH
• Cho BC
• Park JT
• Yoo TH
• Kim BS
• Park HC
• Kang SW
• Lee HY
• Han DS
• Ha SK
• Choi KH

• KMID: 1778147
• DOI: http://doi.org/10.3346/jkms.2009.24.S1.S95

Abstract

The study of cancer in patients treated with dialysis in Korea has not been reported. The aim of this study was to investigate the incidence and mortality of cancer among patients on dialysis in Korea. The study subjects were 106 cancer patients (2.3%) out of 4,562 end-stage renal disease (ESRD) patients maintained on hemodialysis (HD) or peritoneal dialysis (PD) at Yonsei University Health System from 1996 to 2005. We excluded patients in whom the diagnosis of cancer preceded dialysis or those who received renal allograft or started dialysis after renal allograft. Seventy- three (69%) of our subjects were male and 33 (31%) were female. The mean age at the time of cancer diagnosis was 57.9+/-11.7 yr. The mean time from the start of dialysis to the diagnosis of cancer was 75.2+/-63.9 months. The most common cancer site was gastrointestinal tract (GIT) (51%) followed by urinary tract (20%), lung (8%), and thyroid (7%). Sixty nine percent of the total mortality was due to cancer. The mean time from diagnosis to death was 2.9+/-2.5 yr. In ESRD patients with cancer, there were no significant differences in mortality rates by dialysis modality. In ESRD patients, the most common cancer was GIT cancer followed by urinary tract cancer. Therefore, careful surveillance of these cancers in ESRD patients is highly recommended.

Keyword

Neoplasms; Kidney Failure, Chronic; Gastrointestinal tract; Urinary Tract

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Female
Humans
Kidney Failure, Chronic/*complications/epidemiology/*therapy
Korea
Male
Middle Aged
Neoplasms/*complications/epidemiology
*Peritoneal Dialysis
Registries
*Renal Dialysis
Time Factors

Figure

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  Fig. 1 Types of cancer in the general population (%).

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  Fig. 2 Types of cancer in ESRD patients (%).

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  Fig. 3 Frequency of cancer by age between ESRD patients and general population. (A) ESRD patients, (B) general population.

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  Fig. 4 Frequency of cancer by dialysis mode in ESRD patients.

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  Fig. 5 Survival of ESRD patients with cancer. (A) Comparison of survival rate between ESRD patients without cancer and ESRD patients with cancer, (B) Comparison of survival rate by dialysis modality in ESRD patients with cancer.

Reference

1. Cheung AK, Sarnak MJ, Yan G, Dwyer JT, Heyka RJ, Rocco MV, Teehan BP, Levey AS. Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients. Kidney Int. 2000. 58:353–362.

2. Lameire N, Bernaert P, Lambert MC, Vijt D. Cardiovascular risk factors and their management in patients on continuous ambulatory peritoneal dialysis. Kidney Int. 1994. 48:Suppl. S31–S38.

3. Penn I. Occurrence of cancers in immunosuppressed organ transplant recipients. Clin Transpl. 1994. 99–109.

4. Brunner FP, Landais P, Selwood NH. Malignancies after renal transplantation: the EDTA-ERA registry experience: European Dialysis and Transplantation Association-European Renal Association. Nephrol Dial Transplant. 1995. 10:Suppl 1. 74–80.

5. Pecqueux JC, Schwarz A, Dieckmann KP, Offermann G. Cancer incidence in patients on chronic dialysis and in renal transplant recipients. Urol Int. 1990. 45:290–292.

6. Sheil AG, Flavel S, Disney AP, Mathew TH. Cancer development in patients progressing to dialysis and renal transplantation. Transplant Proc. 1985. 17:1685–1688.

7. Matas AJ, Simmons RL, Kjellstrand CM, Buselmeier TJ, Najarian JS. Increased incidence of malignancy during chronic renal failure. Lancet. 1975. 1:883–886.

8. Kinlen LJ, Eastwood JB, Kerr DN, Moorhead JF, Oliver DO, Robinson BH, de Wardener HE, Wing AJ. Cancer in patients receiving dialysis. Br Med J. 1980. 280:1401–1403.

9. Ota K, Yamashita N, Suzuki T, Agishi T. Malignant tumors in dialysis patients:a nationwide survey. Proc Eur Dial Transplant Assoc. 1981. 18:724–730.

10. Bush A, Gabriel R. Cancer in uremic patients. Clin Nephrol. 1984. 22:77–81.

11. Curtis JR. Cancer and patients with end-stage renal failure. Br Med J. 1982. 284:69–70.

12. Schollmeyer P, Bozkurt F. The immune system of the uremic patient: hemodialysis vs CAPD. Clin Nephrol. 1988. 30:Suppl. S37–S40.

13. Bonomini M, Forster S, De Risio F, Rychly J, Nebe B, Manfrini V, Klinkmann H, Albertazzi A. Effects of selenium supplementation on immune parameters in chronic uraemic patients on haemodialysis. Nephrol Dial Transplant. 1995. 10:1654–1661.

14. Fabrizi F, Marcelli D, Bacchini G, Guarnori I, Erba G, Locatelli F. Antibodies to hepatitis C virus (HCV) in chronic renal failure (CRF) patients on conservative therapy: prevalence, risk factors and relationship to liver disease. Nephrol Dial Transplant. 1994. 9:780–784.

15. Yanagisawa H, Manabe S, Kanai Y, Wada O. Carcinogenic glutamic acid pyrolysis product in the dialysate of uremic patients treated by continuous ambulatory peritoneal dialysis. Clin Nephrol. 1988. 30:73–78.

16. Akizawa T, Kinugasa E, Koshikawa S. Increased risk of malignancy and blood-membrane interactions in uraemic patients. Nephrol Dial Transplant. 1994. 9:Suppl 2. S162–S164.

17. Maisonneuve P, Agodoa L, Gellert R, Stewart JH, Buccianti G, Lowenfels AB, Wolfe RA, Jones E, Disney AP, Briggs D, McCredie M, Boyle P. Cancer in patients on dialysis for end-stage renal disease: an international collaborative study. Lancet. 1999. 354:93–99.

18. Cuckovic C, Djukanovic L, Jankovic S, Stanojcic A, Dragicevic P, Radmilovic A, Lambic L, Stojanovic M, Milic M, Bakovic J, Radovic M, Labudovic M. Malignant tumors in hemodialysis patients. Nephron. 1996. 73:710–712.

19. Marple JT, MacDougall M. Development of malignancy in the endstage renal disease patient. Semin Nephrol. 1993. 13:306–314.

20. Shin MH, Oh HK, Ahn YO. Ten year trend of cancer incidence in Seoul, Korea: 1993-2002. J Prev Med Public Health. 2008. 41:92–99.

21. Kjellstrand CM. Are malignancies increased in uraemia? Nephron. 1979. 23:159–161.

22. Cengiz K, Block AM, Hossfeld DK, Anthone R, Anthone S, Sandberg AA. Sister chromatid exchange and chromosome abnormalities in uremic patients. Cancer Genet Cytogenet. 1988. 36:55–67.

23. De Sala O'shea E, Morey Molina A, Ferrutxe Frau J, Gutierrez Sanz-Gadea C, Alarcon Zurita A, Ozonas Moragues M. Cancer of the bladder and hemodialysis. Arch Esp Urol. 1990. 43:359–363.

24. Ishikawa I. Renal cell carcinoma in chronic hemodialysis patients-a 1990 questionnaire study in Japan. Kidney Int. 1993. 41:Suppl. S167–S169.

25. Inamoto H, Ozaki R, Matsuzaki T, Wakui M, Saruta T, Osawa A. Incidence and mortality patterns of malignancy and factors affecting the risk of malignancy in dialysis patients. Nephron. 1991. 59:611–617.

26. Agraharkar ML, Cinclair RD, Kuo YF, Daller JA, Shahinian VB. Risk of malignancy with long-term immunosuppression in renal transplant recipients. Kindey Int. 2004. 66:383–389.

27. Morath C, Mueller M, Goldschmidt H, Schwenger V, Opelz G, Zeier M. Malignancy in renal transplantation. J Am Soc Nephrol. 2004. 15:1582–1588.

28. Kasiske BL, Snyder JJ, Gilbertson DT, Wang C. Cancer after kidney transplantation in the United States. Am J Transplant. 2004. 4:905–913.

29. Niu MT, Coleman PJ, Alter MJ. Multicenter study of hepatitis C virus infection in chronic hemodialysis patients and hemodialysis center staff members. Am J Kidney Dis. 1993. 22:568–573.

30. Basi S, Schulman G, Fogo AB. Multiple complications in multiple myeloma. Am J Kidney Dis. 2005. 45:619–623.

31. Kaptein EM. Thyroid hormone metabolism and thyroid diseases in chronic renal failure. Endocr Rev. 1996. 17:45–63.

32. Vamvakas S, Bahner U, Heidland A. Cancer in end-stage renal disease: potential factors involved. Am J Nephrol. 1998. 18:89–95.

33. Klyachkin ML, Sloan DA. Secondary hyperparathyroidism: evidence for an association with papillary thyroid cancer. Am Surg. 2001. 67:397–399.