Cancer in patients on dialysis for end-stage renal disease

An international collaborative study

Patrick Maisonneuve, Lawrence Agodoa, Ryszard Gellert, John H. Stewart, Gherardo Buccianti, Albert B. Lowenfels, Robert A. Wolfe, Elisabeth Jones, Alex P S Disney, Douglas Briggs, Margaret McCredie, Peter Boyle

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Abstract

Background. Previous studies have suggested that the frequency of cancer is higher in patients with end-stage renal disease (ESRD) than in the general population, but have not established whether this increase is confined to certain cancers or to certain categories of ESRD patients. The aim of this study was to examine the risk of cancer in a large cohort of patients treated by dialysis but not transplantation. Methods. We assembled a cohort of 831,804 patients who received dialysis during the period 1980-94 for ESRD in the USA, Europe, Australia, or New Zealand. We compared the observed frequency of cancer among these patients during 2,045,035 person-years of follow-up with the frequency of cancer in the respective background populations. Findings. During average follow-up of 2.5 years, 25,044 (3%) of 831,804 patients developed cancer compared with an expected number of 21,185 (standardised incidence ratio 1.18 [95% CI 1.17-1.20]). We observed a higher risk of cancer in patients younger than 35 years (3.68 [3.39-3.99]), and the risk gradually decreased with increasing age. High risks were observed for cancer of the kidney (3.60 [3.45-3.76]), bladder (1.50 [1.42-1.57]), and thyroid and other endocrine organs (2.28 [2.03-2.54]). Excess cancers appeared in several organs for which viruses have been suspected as causative agents, whereas cancers of the lung, colorectum, prostate, breast, and stomach were not consistently increased. Interpretation. The overall risk of cancer is increased in patients with ESRD, and the distribution of tumour types resembles the pattern seen after transplantation (although we have no data to make the comparison with skin cancer). The excess risk can largely be ascribed to effects of underlying renal or urinary-tract disease, or of loss of renal function, on the kidney and bladder, and to increased susceptibility to viral carcinogenesis. The relative risk, which is especially high in younger patients, gradually diminishes with age.

Original languageEnglish
Pages (from-to)93-99
Number of pages7
JournalLancet
Volume354
Issue number9173
DOIs
Publication statusPublished - Jul 10 1999

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Chronic Kidney Failure
Dialysis
Neoplasms
Kidney
Urinary Bladder
Transplantation
Urologic Diseases
Kidney Neoplasms
Skin Neoplasms
New Zealand
Population
Prostate
Lung Neoplasms
Stomach
Thyroid Gland
Carcinogenesis
Breast
Viruses
Incidence

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Maisonneuve, P., Agodoa, L., Gellert, R., Stewart, J. H., Buccianti, G., Lowenfels, A. B., ... Boyle, P. (1999). Cancer in patients on dialysis for end-stage renal disease: An international collaborative study. Lancet, 354(9173), 93-99. https://doi.org/10.1016/S0140-6736(99)06154-1

Cancer in patients on dialysis for end-stage renal disease : An international collaborative study. / Maisonneuve, Patrick; Agodoa, Lawrence; Gellert, Ryszard; Stewart, John H.; Buccianti, Gherardo; Lowenfels, Albert B.; Wolfe, Robert A.; Jones, Elisabeth; Disney, Alex P S; Briggs, Douglas; McCredie, Margaret; Boyle, Peter.

In: Lancet, Vol. 354, No. 9173, 10.07.1999, p. 93-99.

Research output: Contribution to journalArticle

Maisonneuve, P, Agodoa, L, Gellert, R, Stewart, JH, Buccianti, G, Lowenfels, AB, Wolfe, RA, Jones, E, Disney, APS, Briggs, D, McCredie, M & Boyle, P 1999, 'Cancer in patients on dialysis for end-stage renal disease: An international collaborative study', Lancet, vol. 354, no. 9173, pp. 93-99. https://doi.org/10.1016/S0140-6736(99)06154-1
Maisonneuve, Patrick ; Agodoa, Lawrence ; Gellert, Ryszard ; Stewart, John H. ; Buccianti, Gherardo ; Lowenfels, Albert B. ; Wolfe, Robert A. ; Jones, Elisabeth ; Disney, Alex P S ; Briggs, Douglas ; McCredie, Margaret ; Boyle, Peter. / Cancer in patients on dialysis for end-stage renal disease : An international collaborative study. In: Lancet. 1999 ; Vol. 354, No. 9173. pp. 93-99.
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abstract = "Background. Previous studies have suggested that the frequency of cancer is higher in patients with end-stage renal disease (ESRD) than in the general population, but have not established whether this increase is confined to certain cancers or to certain categories of ESRD patients. The aim of this study was to examine the risk of cancer in a large cohort of patients treated by dialysis but not transplantation. Methods. We assembled a cohort of 831,804 patients who received dialysis during the period 1980-94 for ESRD in the USA, Europe, Australia, or New Zealand. We compared the observed frequency of cancer among these patients during 2,045,035 person-years of follow-up with the frequency of cancer in the respective background populations. Findings. During average follow-up of 2.5 years, 25,044 (3{\%}) of 831,804 patients developed cancer compared with an expected number of 21,185 (standardised incidence ratio 1.18 [95{\%} CI 1.17-1.20]). We observed a higher risk of cancer in patients younger than 35 years (3.68 [3.39-3.99]), and the risk gradually decreased with increasing age. High risks were observed for cancer of the kidney (3.60 [3.45-3.76]), bladder (1.50 [1.42-1.57]), and thyroid and other endocrine organs (2.28 [2.03-2.54]). Excess cancers appeared in several organs for which viruses have been suspected as causative agents, whereas cancers of the lung, colorectum, prostate, breast, and stomach were not consistently increased. Interpretation. The overall risk of cancer is increased in patients with ESRD, and the distribution of tumour types resembles the pattern seen after transplantation (although we have no data to make the comparison with skin cancer). The excess risk can largely be ascribed to effects of underlying renal or urinary-tract disease, or of loss of renal function, on the kidney and bladder, and to increased susceptibility to viral carcinogenesis. The relative risk, which is especially high in younger patients, gradually diminishes with age.",
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