J Korean Med Sci.  2019 Jul;34(25):e176. 10.3346/jkms.2019.34.e176.

The Incidences and Characteristics of Various Cancers in Patients on Dialysis: a Korean Nationwide Study

Affiliations
  • 1Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
  • 2Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Korea. gilwon67@chungbuk.ac.kr
  • 3Department of Health Information and Management, Chungbuk National University College of Medicine, Cheongju, Korea.
  • 4College of Business, Chungbuk National University, Cheongju, Korea.
  • 5Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.

Abstract

BACKGROUND
The numbers of patients on dialysis and their life expectancies are increasing. Reduced renal function is associated with an increased risk of cancer, but the cancer incidence and sites in dialysis patients compared with those of the general population require further investigation. We investigated the incidences of various cancers in dialysis patients in Korea and used national health insurance data to identify cancers that should be screened in dialysis clinics.
METHODS
We accessed the Korean National Health Insurance Database and excerpted data using the International Classification of Disease codes for dialysis and malignancies. We included all patients who commenced dialysis between 2004 and 2013 and selected the same number of controls via propensity score matching.
RESULTS
A total of 48,315 dialysis patients and controls were evaluated; of these, 2,504 (5.2%) dialysis patients and 2,201 (4.6%) controls developed cancer. The overall cancer risk was 1.54-fold higher in dialysis patients than in controls (adjusted hazard ratio, 1.71; 95% confidence interval, 1.61-1.81). The cancer incidence rate (incidence rate ratio [IRR], 3.27) was especially high in younger dialysis patients (aged 0-29 years). The most common malignancy of end-stage renal disease patients and controls was colorectal cancer. The major primary cancer sites in dialysis patients were liver and stomach, followed by the lung, kidney, and urinary tract. Kidney cancer exhibited the highest IRR (6.75), followed by upper urinary tract (4.00) and skin cancer (3.38). The rates of prostate cancer (0.54) and oropharyngeal cancer (0.72) were lower than those in the general population.
CONCLUSION
Dialysis patients exhibited a higher incidence of malignancy than controls. Dialysis patients should be screened in terms of colorectal, liver, lung, kidney and urinary tract malignancies in dialysis clinics.

Keyword

Renal Dialysis; Cancer; Epidemiology; Population

MeSH Terms

Colorectal Neoplasms
Dialysis*
Epidemiology
Humans
Incidence*
International Classification of Diseases
Kidney
Kidney Failure, Chronic
Kidney Neoplasms
Korea
Life Expectancy
Liver
Lung
National Health Programs
Oropharyngeal Neoplasms
Propensity Score
Prostatic Neoplasms
Renal Dialysis
Skin Neoplasms
Stomach
Urinary Tract
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