Higher risk of urothelial carcinoma in the upper urinary tract than in the urinary bladder in hemodialysis patients

Abstract

Purpose This study used the a nationwide population-based retrospective cohort study with the claims data from the Taiwan National Health Insurance Research Database to investigate the risk of urothelial carcinoma (UC) for hemodialysis (HD) patients. Methods The study population consisted of 2689 patients with end-stage renal disease (ESRD) newly diagnosed in 2000–2002 and underwent maintenance HD. Then, 21,449 reference patients were collected without HD randomly selected and matched with sex and age. The exclusion criteria were previous long-term analgesics and Chinese medication usage. Incidence density rates of UC in upper urinary tract (UTUC) and bladder (UBUC) were estimated for both cohorts by the end of 2012. Hazard ratios (HRs) of UC were measured in association with HD, covariates, and comorbidity. Results The incidence of UC was significantly higher in the HD cohort than in the reference cohort for both UT (21.8 vs. 0.65 per 10,000 person-years) and UB (17.7 vs. 3.55 per 10,000 person-years). The multivariate Cox proportional hazard regression analysis showed that the HRs of UTUC in HD cohort was 33.3 (95% CI = 15.9–69.5) and 5.14 for UBUC (95% CI = 3.24–8.15). The risk increased further for HD patients with comorbidity of hematuria, urinary tract infection (UTI) or hydronephrosis. Conclusion Patients with ESRD on HD are at a high risk of developing UC, especially UTUC in Taiwan. They will be paid more frequent to check urine analysis, urine cytology, and upper urinary tract survey.

Keywords:

• End-stage renal disease
• hemodialysis
• urinary bladder
• upper urinary tract
• urothelial carcinoma,

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Funding information

This study was supported partly by the Department of Health, Executive Yuan, Taiwan, Republic of China (grant number DOH 97-HP-1101, 2008–2010), the Clinical Trial and Research Center for Excellence (grant number DOH100-TD-B-111–004) the Cancer Research Center of Excellence (DOH100-TD-C-111–005), and China Medical University Hospital (grant number 1MS1).