Cancer before and after the start of hemodialysis and association with mortality – an Eastern-European multicenter study

Abstract

Introduction

East-European data on cancer in patients undergoing hemodialysis (HD) are scarce. This study aimed to assess the pattern of cancer and related mortality in patients with end-stage kidney disease (ESKD) undergoing HD.

Methods

Retrospectively analyzing data from 7 HD centers, this study examined 1377 incident HD patients divided into three groups: no-cancers (NoC), cancers that occurred prior to HD initiation (CPI) and de novo cancer developed after HD initiation (DNC). Mortality risk and survival trends within groups were analyzed using Cox regression and Kaplan-Meier methods.

Results

In the cohort, 89.46% of the patients had no cancer (NoC group), 3.63% had cancer before (CPI group), and 6.89% had cancer after HD initiation (DNC group). The mean time from HD initiation to DNC diagnosis was 1 [2.75] years. Older age was associated with a higher risk of developing DNC (p < 0.001). Chronic tubulointerstitial nephritis (CTIN) is more prevalent in cancer patients. The most common cancer sites among DNC patients were the digestive (29.47%) and urinary tracts (18.95%), while those in CPI subjects were hematologic (22%) and digestive (20%). Cancer was an independent predictor of mortality risk (HR = 6.9, 95% [CI]:4.5–10.6, p < 0.001).

Conclusions

East-European ESKD patients undergoing HD have a high incidence of de novo cancers whose primary cancer sites are the digestive and urinary tracts. Almost half of the HD patients with CPI have hematologic and digestive tract cancers. Age and CTIN were associated with cancer risk. Cancer is an independent risk factor for all-cause mortality in patients undergoing hemodialysis (HD).

Keywords:

• Cancer
• East European multicenter study
• end-stage kidney disease
• hemodialysis patients
• mortality
• risk

Acknowledgments

The authors are grateful to Marius Parv for his assistance in editing and translating this manuscript.

Author contributions

FG, MC, AA and AS designed the study and wrote the manuscript. OS, VI, LP, FB, OM, ASS, MG, FP, and RT: collected and entered data; BT - performed the statistical analysis; FG, MC, BT, and AS contributed to data acquisition and interpretation; FG, MC, LP, FP, RT, and AS critically reviewed and revised the article. All the authors have read and approved the final manuscript.

Ethical statement

The study was approved by the BBraun Avitum Ltd. Romania Ethical Committee (Board of Human Studies), and all patients provided written informed consent before enrollment. This study was conducted in accordance with the requirements of the Declaration of Helsinki.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The original contributions of this study are included in the article/supplementary material. Further inquiries can be directed to the corresponding authors.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.