Cancer in Korean patients with end-stage renal disease: A 7-year follow-up

<div><p>Background</p><p>The effectiveness of dialysis on the incidence of cancer in patients with end-stage renal disease (ESRD) remains to be clarified. In this study, we evaluated the incidence rate and type of cancer among patients with ESRD, compared to the general population, through a prospective 7-year follow-up. We also calculated the cumulative incidence rate of cancer associated with ESRD, with stratification to control for the competing risk of death.</p><p>Methods</p><p>This prospective observational cohort study was conducted using data from a nationwide study on patients with ESRD in Korea. A total of 5,235 patients, ≥18 years old, with ESRD were identified from the national registry as being treated by dialysis between August 2008 and December 2014. The standardized incidence ratio (SIR) and cumulative incidence rate of specific cancers were evaluated and compared to the general population.</p><p>Results</p><p>A total of 5,235 participants were included. During the 7 year observation period, 116 (2.2%) participants had been diagnosed as cancer. The SIR of overall cancer was 0.94 [95% confidence interval (CI), 0.72–1.19] and was comparable to the rate for the general population. Although the digestive organs were the most frequent site of a primary site cancer (N = 39, 33.6%), the SIR was highest for urinary tract cancer [4.7, 95% CI, 2.42–8.19]. The five year standardized cumulative incidence of cancer was higher for females than for males, and for non-diabetic compared to diabetic causes of ESRD. We estimated that the five year standardized cumulative incidence was highest [8.4, 95% CI, 5.07–13.75] in patients with ESRD, caused by glomerulonephritis.</p><p>Conclusion</p><p>A screening program should be necessary for urinary tract cancer in Korean patients with ESRD. Cancer screening programs for patients with ESRD in Korea should be emphasized on female patients and patients with non-diabetic ESRD.</p></div

Early dialysis initiation does not improve clinical outcomes in elderly end-stage renal disease patients: A multicenter prospective cohort study

<div><p>Background</p><p>The optimal timing for initiating dialysis in end-stage renal disease (ESRD) is controversial, especially in the elderly.</p><p>Methods</p><p>665 patients ≥65 years old who began dialysis from August 2008 to February 2015 were prospectively enrolled in the Clinical Research Center for End-Stage Renal Disease cohort study. Participants were divided into 2 groups based on the median estimated glomerular filtration rate at the initiation of dialysis. Propensity score matching (PSM) was used to compare the overall survival rate, cardiovascular events, Kidney Disease Quality of Life Short Form 36 (KDQOL-36) results, Karnofsky performance scale values, Beck’s depression inventory values, and subjective global assessments.</p><p>Results</p><p>The mean patient age was 72.0 years, and 61.7% of the patients were male. Overall, the cumulative survival rates were lower in the early initiation group, although the difference was not significant after PSM. Additionally, the survival rates of the 2 groups did not differ after adjusting for age, sex, Charlson comorbidity index and hemoglobin, serum albumin, serum calcium and phosphorus levels. Although the early initiation group showed a lower physical component summary score on the KDQOL-36 3 months after dialysis, the difference in scores was not significant 12 months after dialysis. Furthermore, the difference was not significant after PSM. The Karnofsky performance scale, Beck’s depression inventory, and subjective global assessments were not significantly different 3 and 12 months after dialysis initiation.</p><p>Conclusions</p><p>The timing of dialysis initiation is not associated with clinical outcomes in elderly patients with ESRD.</p></div

Comparison of the standardized cumulative incidence ratio controlling for the competing risk of death from any other cause stratified by primary cause of end-stage renal disease.

<p>Comparison of the standardized cumulative incidence ratio controlling for the competing risk of death from any other cause stratified by primary cause of end-stage renal disease.</p

Standard incidence ratios of cancer among ESRD patients by primary site of the cancer, diagnosed between 2009 and 2012.

<p>Standard incidence ratios of cancer among ESRD patients by primary site of the cancer, diagnosed between 2009 and 2012.</p

Lower serum potassium associated with increased mortality in dialysis patients: A nationwide prospective observational cohort study in Korea - Fig 3

<p><b>Cumulative mortality incidence in patients with end-stage renal disease undergoing hemodialysis (A) or peritoneal dialysis (B).</b> Mortality incidence was plotted according to the level of serum potassium.</p

Standard incidence ratios of cancer among ESRD patients by age, diagnosed between 2009 and 2012.

<p>Standard incidence ratios of cancer among ESRD patients by age, diagnosed between 2009 and 2012.</p

The five-year standardized cumulative incidence ratio controlled for the competing risk for death of any type of cancer.

<p>The five-year standardized cumulative incidence ratio controlled for the competing risk for death of any type of cancer.</p

Comparison of the standardized cumulative incidence ratio controlling for the competing risk of death from any other cause stratified by age at the initiation of dialysis.

<p>Comparison of the standardized cumulative incidence ratio controlling for the competing risk of death from any other cause stratified by age at the initiation of dialysis.</p

The distribution of causes of death in the study patients.

<p>In the entire study cohort, the distribution of causes of death was similar for serum potassium levels below and above 4.5 mmol/L. However, subsequent analysis established that patients undergoing hemodialysis and those undergoing peritoneal dialysis show slightly different distribution of causes of death. Specifically, hemodialysis patients with serum potassium ≥4.5 mmol/L were more likely to die of cardiovascular disease than those with serum potassium < 4.5 mmol/L. On the other hand, peritoneal dialysis patients with serum potassium ≥4.5 mmol/L displayed a tendency to die of infection than those with serum potassium < 4.5 mmol/L, although insignificant.</p

Forest plot representing log hazard ratios for mortality risk in the entire study cohort patients with serum potassium < 4.5 mmol/L.

<p>Results assessed according to known or potential risk factors. Abbreviations: DM, diabetes mellitus; CHF, congestive heart failure; CVD, cardiovascular disease; BMI, body mass index; hs-CRP, high sensitivity C-reactive protein.</p