Cancer is a significant cause of morbidity in the population with kidney failure, however cancer mortality in people undergoing dialysis is not well described. We sought to compare cancer mortality in people on dialysis for kidney failure to cancer mortality in the general population.
A retrospective cohort study using linked health-administrative and dialysis registry data.
All people receiving dialysis represented in the Australian and New Zealand Dialysis and Transplantation Registry, 1980-2013.
Dialysis; hemodialysis (HD) and peritoneal dialysis (PD).
Death and underlying cause of death ascertained using health-administrative data and classified using ICD-10-AM codes.
Indirect standardization on age-at-death, sex, year and country to estimate standardized mortality ratios (SMR).
34,100 deaths occurred among 59,648 people on dialysis over 269,598 person-years of observation, including 3,677 cancer deaths. The relative risk of all-site cancer death in dialysis was twice (SMR 2.4 95%CI 2.33-2.49) that of the general population and highest for oral and pharynx cancers (SMR 24.3; 95%CI 18.0-31.5) and multiple myeloma (SMR 22.5; 95%CI 20.3-23.9). Women on dialysis had significantly higher risk of all-site cancer mortality (SMR 2.7; 95%CI 2.59-2.89) compared to men (SMR 2.3; 95% CI 2.17-2.36; p<0.001). People on HD (SMR 2.2; 95%CI 2.11-2.30) experienced greater excess deaths from all-site cancer compared to people on PD (SMR 1.3; 95%CI 1.23-1.44). Excess deaths have gradually decreased over time for all-site, multiple myeloma and kidney cancers (p-value <0.001) but have not kept up with improvements in the general population. In contrast, among people receiving dialysis, excess deaths increased for colorectal and lung cancers (p-value<0.001).
Confirmation of cancer diagnoses and population incidence data were not available; inability to exclude pre-existing cancers.
People on dialysis experience excess all-site and site-spcific cancer mortality compared to the general population. Mortality differs by modality type, age, and sex. Understanding the role of kidney failure and other morbidities in the treatment of cancer is important for shared decision making regarding cancer treatments and identifying potential approaches to improve outcomes.
American journal of kidney diseases : the official journal of the National Kidney Foundation. 2022 Apr 29 [Epub ahead of print]
Brenda M Rosales, Nicole De La Mata, Claire M Vajdic, Patrick J Kelly, Kate Wyburn, Angela C Webster
The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health. Electronic address: ., The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health., University of New South Wales, Centre for Big Data Research in Health., The University of Sydney, Faculty of Medicine and Health, Central Clinical School; Royal Prince Alfred Hospital, Renal Medicine., The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health; Centre for Transplant and Renal Research, Westmead Hospital.