Dialysis and the risk of early urological cancer: A nationwide population-based cohort study in Taiwan

Abstract

Patients with end-stage renal disease (ESRD) are predisposed to a higher risk of developing malignancies. This study aimed to explore the association between chronic dialysis with ESRD treated and the subsequent development of urothelial cell carcinoma or renal cell carcinoma (UC/RCC). Data spanning 13 years were retrieved from Taiwan's National Health Insurance Research Database. A total of 11,820 patients with ESRD undergoing maintenance dialysis between January 1, 2000, and December 31, 2013, and 35,460 controls matched for sex, age, and index year, were identified. After adjusting for confounding factors, Cox proportional hazards analysis was performed to compare the risk of UC/RCC during the 13-year follow-up period, and Kaplan-Meier analysis was used to evaluate the cumulative UC/RCC incidence between the ESRD and non-ESRD cohorts. The average time before developing UC/RCC was 4.18 years after dialysis initiation in the ESRD group compared to 5.39 years in the control group. After adjusting for sex, age, monthly income, urbanization level, geographic region, and comorbidities, the hazard ratio for UC/RCC was 1.186 (95% confidence interval, 1.071-1.448; P = .005). Stratified by age, the odds ratios (ORs) for developing UC/RCC were 2.105, 1.498, 1.371, and 0.925 among patients with ESRD aged 40 to 49, 50 to 59, 60 to 69, and ≥ 70 years, respectively. Stratification by comorbidities revealed ORs of 1.204, 1.179, 1.186,1.172, 1.211, and 1.210 for patients without diabetes mellitus, hyperlipidemia, obesity, coronary artery disease, chronic obstructive pulmonary disease, and hematuria, respectively. The mean time to UC/RCC occurrence was 4.18 years after dialysis. Furthermore, younger male patients undergoing dialysis with fewer comorbidities were at higher risk of developing UC/RCC. Early or more intensive surveillance for urological cancers post-dialysis initiation is recommended for patients undergoing dialysis with longer life expectancies or a higher likelihood of undergoing renal transplantation.

Keywords: chronic dialysis; renal cell carcinoma; urological cancer; urothelial cell carcinoma.