Korean J Intern Med.  2020 Sep;35(5):1210-1219. 10.3904/kjim.2018.400.

Cancer incidence according to the National Health Information Database in Korean patients with end-stage renal disease receiving hemodialysis

Affiliations
  • 1Biostatistical Consulting and Research Laboratory, Medical Research Coordinating Center, Hanyang University, Seoul, Korea
  • 2Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
  • 3Department of Occupational and Environmental Medicine, Hanyang University College of Medicine, Seoul, Korea

Abstract

Background/Aims
The aim of this study was to investigate incidence, survival, and risk factors of cancer in end-stage renal disease (ESRD) patients with hemodialysis using information from the National Health Information Database (NHID).
Methods
Using the NHID, we identified ESRD patients who started maintenance hemodialysis between 2003 and 2005 in Korea. Patients were followed from initiation of hemodialysis to renal transplantation, death, or December 31, 2016, whichever came first. We calculated the incidence, survival, and risk factors of cancer.
Results
Of the total 14,382 ESRD patients, 1,124 (7.82%; men:women, 728:396) were diagnosed with cancer during follow-up. The mean duration from the start of hemodialysis to new cancer identification was 64.40 ± 41.81 months. Significant risk factors for the development of new cancer were old age, male sex, and liver disease. Conversely, patients with diabetes showed low risk for new cancer. The colorectum (17.31%) was the most common primary site of cancer in men, followed by the liver (15.8%), stomach (14.29%), lung (13.6%), and kidney (10.3%). In women, the colorectum (14.65%) was also the most common primary site of cancer, followed by the breast (12.88%), thyroid (12.63%), stomach (10.86%), and lung (8.08%). According to the primary site of cancer, breast cancer showed the longest median survival duration (130.93 months), followed by thyroid, kidney, colorectum, bladder, stomach, liver, and lung cancer. On multivariate analyses, overall survival was affected by age and diabetes.
Conclusions
The cancer incidence of chronic hemodialysis patients was relatively high. Thus, careful monitoring and a specific cancer screening program are needed for chronic hemodialysis patients.

Keyword

Renal dialysis; Kidney failure; chronic; Neoplasms
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