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

Figures & data

Figure 1. Flow chart of the selection of the ESRD patients with HD according to the National Health Insurance Research Database.

Table 1. Comparisons in sociodemographic factors between cohorts with and without hemodialysis.

	Hemodialysis*
	No N = 21,449		Yes N = 2689		Total N = 24,138
	n	(%)	n	(%)	n	(%)	p-Values
Gender							0.09
Female	10,625	(49.5)	1286	(47.8)	11,911	(49.4)
Male	10,824	(50.5)	1403	(52.2)	12,227	(50.6)
Age, years							<0.001
20–59	8055	(37.6)	1011	(37.6)	9066	(37.6)
60–74	9548	(44.5)	1041	(38.7)	10,589	(43.9)
≥75	3846	(17.9)	637	(23.7)	4483	(18.6)
Occupation							<0.001
White collar	6981	(32.6)	654	(24.3)	7635	(31.6)
Blue collar	8921	(41.6)	1259	(46.8)	10,180	(42.2)
Others	5547	(25.9)	776	(28.9)	6323	(26.2)
Urbanization**							0.003
Low	3710	(17.3)	559	(20.8)	4269	(17.7)
Moderate	4440	(20.7)	563	(20.9)	5003	(20.7)
High	13,299	(62.0)	1567	(58.3)	14,866	(61.6)
Region							<0.001
North	9317	(43.4)	975	(36.3)	10,292	(42.6)
Central	4352	(20.3)	555	(20.6)	4907	(20.3)
South	5762	(26.9)	795	(29.6)	6557	(27.2)
East and Island	2018	(9.4)	364	(13.5)	2382	(9.9)
Income, NTD							<0.001
<10,000	11,012	(51.3)	1,593	(59.2)	12,605	(52.2)
10,000–24,999	7516	(35.0)	950	(35.3)	8466	(35.1)
≥25,000	2921	(13.6)	146	(5.4)	3067	(12.7)

Notes:

* Frequency of hemodialysis ≥3 times.

** Low = first and second quartile of density of population, moderate = third quartile of density of population, high = fourth quartile of density of population.

Table 2. Incidence density of UTUCs stratified by sociodemographic status in hemodialysis cohort and nonhemodialysis cohort.

	Hemodialysis
	No			Yes
	Case	Person-year	Rate^a	Case	Person-year	Rate^a	Ratio^b
All	9	137,819	0.65	37	16,948	21.8	33.4
Gender
Female	4	68,404	0.58	21	8101	25.9	44.3
Male	5	69,415	0.72	16	8847	18.1	25.1
Age, years
20–59	1	51,890	0.19	12	6413	18.7	97.1
60–74	4	61,523	0.65	20	6558	30.5	46.9
≥75	4	24,406	1.64	5	3978	12.6	7.7
Occupation
White collar	3	44,876	0.67	6	4122	14.6	21.8
Blue collar	4	57,318	0.70	22	7937	27.7	39.7
Others	2	35,625	0.56	9	4889	18.4	32.8
Urbanization
Low	2	23,921	0.84	10	3525	28.4	33.9
Moderate	2	28,490	0.70	8	3565	22.4	32.0
High	5	85,409	0.59	19	9858	19.3	32.9
Region
North	2	59,842	0.33	7	6186	11.3	33.9
Central	2	27,939	0.72	10	3536	28.3	39.5
South	5	37,021	1.35	19	4928	38.6	28.5
East and Island	0	13,018	–	1	2298	4.4	–
Income, NTD
<10,000	6	70,838	0.85	16	10,049	15.9	18.8
10,000–24,999	2	48,231	0.41	20	5989	33.4	80.5
≥25,000	1	18,750	0.53	1	910	11.0	20.6

Notes:

^a per 10,000 person-years.

^b all p < 0.001.

Table 3. Incidence density of UBUCs stratified by sociodemographic status in hemodialysis cohort and non-hemodialysis cohort.

	Hemodialysis
	No			Yes
	Case	Person-years	Rate^a	Case	Person-years	Rate^a	Ratio^b
All	49	137,987	3.55	30	16,932	17.7	5.0
Gender
Female	13	68,446	1.90	14	8,101	17.3	9.1
Male	36	69,541	5.18	16	8,831	18.1	3.5
Age, years
20–59	9	51,921	1.73	11	3,392	32.4	18.7
60–74	26	61,610	4.22	14	6,557	21.4	5.1
≥75	14	24,457	5.72	5	3,983	12.6	2.2
Occupation
White collar	15	44,927	3.34	8	4,133	19.4	5.8
Blue collar	13	57,353	2.27	13	7,904	16.5	7.3
Others	21	35,708	5.88	9	4,896	18.4	3.1
Urbanization
Low	5	23,932	2.09	5	3,509	14.3	6.8
Moderate	9	28,518	3.16	3	3,545	8.5	2.7
High	35	85,537	4.09	22	9,879	22.3	5.4
Region
North	21	59,927	3.50	9	6,194	14.5	4.1
Central	14	27,989	5.00	7	3,518	19.9	4.0
South	10	37,040	2.70	11	4,908	22.4	8.3
East and Island	4	13,032	3.07	3	2,312	13.0	4.2
Income, NTD
<10,000	35	70,961	4.93	18	10,064	17.9	3.6
10,000–24,999	10	48,261	2.07	10	5,949	16.8	8.1
≥25,000	4	18,765	2.13	2	919	2.1	10.3

Notes: ^aper 10,000 person-years; ^ball p < 0.05.

Table 4. Hazard ratios and 95% confidence intervals of developing UTUCs and UBUCs associated with hemodialysis controlling for sociodemographic factors.

	Upper urinary tract (UTUC)				Bladder (UBUC)
	Crude		Adjusted		Crude		Adjusted
	HR	(95% CI)	HR	(95% CI)	HR	(95% CI)	HR	(95% CI)
Gender
Male	1.00	(reference)	1.00	(reference)	1.00	(reference)	1.00	(reference)
Female	0.82	(0.46–1.47)	1.24	(0.69–2.24)	1.88	(1.18–3.00)*	1.82	(1.14–2.91)*
Age, years
20–59	1.00	(reference)	1.00	(reference)	1.00	(reference)	1.00	(reference)
60–74	1.59	(0.81–3.12)	1.77	(0.87–3.61)	1.71	(1.00–2.92)	1.80	(1.00–3.24)*
≥75	1.42	(0.61–3.31)	1.20	(0.50–2.92)	1.96	(1.05–3.67)*	1.76	(0.89–3.47)
Occupation
White collar	1.00	(reference)	1.00	(reference)	1.00	(reference)	1.00	(reference)
Blue collar	2.15	(1.01–4.59)*	1.12	(0.42–2.99)	0.85	(0.49–1.49)	0.88	(0.43–1.81)
Others	1.46	(0.61–3.52)	1.19	(0.47–3.05)	1.58	(0.92–2.72)	1.17	(0.65–2.10)
Urbanization
Low	1.73	(0.86–3.45)	1.08	(0.50–2.34)	1.00	(reference)	1.00	(reference)
Moderate	1.24	(0.59–2.59)	0.97	(0.45–2.08)	1.03	(045–2.38)	1.07	(0.48–2.50)
High	1.00	(reference)	1.00	(reference)	1.64	(0.84–3.21)	1.69	(0.82–3.52)
Income, NTD
<10,000	1.00	(reference)	1.00	(reference)	2.14	(0.92–4.99)	1.14	(0.43–3.04)
10,000–24,999	1.50	(0.83–2.70)	1.68	(0.67–4.20)	1.21	(0.49–3.02)	1.08	(0.37–3.17)
≥25,000	0.39	(0.09–1.62)	1.07	(0.22–5.15)	1.00	(reference)	1.00	(reference)
Hemodialysis
No	1.00	(reference)	1.00	(reference)	1.00	(reference)	1.00	(reference)
Yes	32.4	(15.6–67.3)**	33.3	(15.9–69.5)**	5.08	(3.22–8.01)**	5.14	(3.24–8.15)**

Notes: *p < 0.05; **p < 0.001.

Table 5. Hazard ratios of UCs in hemodialysis patients with comorbid hematuria, UTI, and hydronephrosis controlling for sociodemographic status.

	Urothelial carcinoma
	Upper urinary tract		Bladder
	HR	95% CI	HR	95% CI
No	1.00	(reference)	1.00	(reference)
Hematuria and HD	87.0	(48.1–157)***	16.8	(9.80–28.7)***
UTI and HD	11.0	(6.10–19.9)***	3.54	(2.03–6.16)***
Hydronephrosis and HD	38.7	(20.2–74.0)***	11.0	(5.07–24.0)***

Note: ***p < 0.001, all factors control for sex and age.