Cancer before and after the start of hemodialysis and association with mortality – an Eastern-European multicenter study
Florica Gadalean,
Mircea Ciorcan,
Adrian Apostol,
Oana Schiller,
Viviana Ivan,
Ligia Petrica,
Flaviu Bob,
Oana Milas,
Anca Simulescu,
Mihaela Glavan,
Florina Parv,
Bogdan Timar,
Romulus Timar,
Adalbert Schiller
Affiliations
Florica Gadalean
Department of Internal Medicine II, Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy Timisoara, Timișoara, Romania
Mircea Ciorcan
Department of Internal Medicine, Division of Practical Clinical Skills, “Victor Babeș” University of Medicine and Pharmacy Timisoara, Timișoara, Romania
Adrian Apostol
Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
Oana Schiller
Avitum BBraun, Timisoara, Romania
Viviana Ivan
Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
Ligia Petrica
Department of Internal Medicine II, Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy Timisoara, Timișoara, Romania
Flaviu Bob
Department of Internal Medicine II, Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy Timisoara, Timișoara, Romania
Oana Milas
Department of Internal Medicine II, Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy Timisoara, Timișoara, Romania
Anca Simulescu
Department of Internal Medicine II, Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy Timisoara, Timișoara, Romania
Mihaela Glavan
Department of Internal Medicine II, Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy Timisoara, Timișoara, Romania
Florina Parv
Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
Bogdan Timar
County Emergency Hospital Timisoara, Timișoara, Romania
Romulus Timar
County Emergency Hospital Timisoara, Timișoara, Romania
Adalbert Schiller
Department of Internal Medicine II, Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy Timisoara, Timișoara, Romania
AbstractIntroduction 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).