Is there different risk of cancer among end‐stage renal disease patients undergoing hemodialysis and peritoneal dialysis?

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Abstract

Cancer is a global issue in recent decade. Despite this alarming increase in the incidence of cancer, to date, whether the risk of developing cancer differs among peritoneal dialysis ( PD) and hemodialysis ( HD) patients is still uncertain. In this retrospective cohort study, data were obtained from the National Health Insurance Research Database of Taiwan, which provides coverage to almost 99% of the nation's population. After matching, a total of 4491 (or 3369) incident PD patients and 8982 (or 6738) incident HD patients between 2000 and 2009 were enrolled from the database. In addition, 22,455 (or 16,845) nondialysis patients were selected as a control group. The patients were monitored for the occurrence of cancer until 2010, and their data were analyzed using several different models. In general, the results showed that the risks of hepatocellular, kidney, bladder, extra kidney/bladder urinary tract, and thyroid cancers were higher in dialysis patients. We also compared the risk of cancer between two dialysis groups by using the HD patients as the reference group. The result showed that there is no significant different for each cancer risk between two dialysis groups. In conclusion, dialysis patients had a higher risk of certain types of cancer than those in the nonuremia group. However, there was no significant difference in the cancer risk between the two dialysis groups when compared directly.

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Most cited references 45

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Peritoneal dialysis and epithelial-to-mesenchymal transition of mesothelial cells.

María Yañez-Mó, Enrique Lara-Pezzi, Rafael Selgas … (2003)

During continuous ambulatory peritoneal dialysis, the peritoneum is exposed to bioincompatible dialysis fluids that cause denudation of mesothelial cells and, ultimately, tissue fibrosis and failure of ultrafiltration. However, the mechanism of this process has yet to be elucidated. Mesothelial cells isolated from effluents in dialysis fluid from patients undergoing continuous ambulatory peritoneal dialysis were phenotypically characterized by flow cytometry, confocal immunofluorescence, Western blotting, and reverse-transcriptase polymerase chain reaction. These cells were compared with mesothelial cells from omentum and treated with various stimuli in vitro to mimic the transdifferentiation observed during continuous ambulatory peritoneal dialysis. Results were confirmed in vivo by immunohistochemical analysis performed on peritoneal-biopsy specimens. Soon after dialysis is initiated, peritoneal mesothelial cells undergo a transition from an epithelial phenotype to a mesenchymal phenotype with a progressive loss of epithelial morphology and a decrease in the expression of cytokeratins and E-cadherin through an induction of the transcriptional repressor snail. Mesothelial cells also acquire a migratory phenotype with the up-regulation of expression of alpha2 integrin. In vitro analyses point to wound repair and profibrotic and inflammatory cytokines as factors that initiate mesothelial transdifferentiation. Immunohistochemical studies of peritoneal-biopsy specimens from patients undergoing continuous ambulatory peritoneal dialysis demonstrate the expression of the mesothelial markers intercellular adhesion molecule 1 and cytokeratins in fibroblast-like cells entrapped in the stroma, suggesting that these cells stemmed from local conversion of mesothelial cells. Our results suggest that mesothelial cells have an active role in the structural and functional alteration of the peritoneum during peritoneal dialysis. The findings suggest potential targets for the design of new dialysis solutions and markers for the monitoring of patients. Copyright 2003 Massachusetts Medical Society

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Aristolochic acid nephropathy: a worldwide problem.

Frédéric Debelle, Jean-Louis Vanherweghem, Joëlle Nortier (2008)

Aristolochic acid nephropathy (AAN), a progressive renal interstitial fibrosis frequently associated with urothelial malignancies, was initially reported in a Belgian cohort of more than 100 patients after the intake of slimming pills containing a Chinese herb, Aristolochia fangchi. Although botanicals known or suspected to contain aristolochic acid (AA) were no longer permitted in many countries, several AAN cases were regularly observed all around the world. The incidence of AAN is probably much higher than initially thought, especially in Asia and the Balkans. In Asian countries, where traditional medicines are very popular, the complexity of the pharmacopoeia represents a high risk for AAN because of the frequent substitution of the botanical products by AA-containing herbs. In the Balkan regions, the exposure to AA found in flour obtained from wheat contaminated with seeds of Aristolochia clematitis could be responsible for the so-called Balkan-endemic nephropathy. Finally, despite the Food and Drug Administration's warnings concerning the safety of botanical remedies containing AA, these herbs are still sold via the Internet.

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Cancer in patients on dialysis for end-stage renal disease: an international collaborative study.

G Buccianti, A Lowenfels, L Agodoa … (1999)

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. 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. 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. 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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Author and article information

Contributors

Sheng‐Hsiang Lin: shlin922@mail.ncku.edu.tw

Journal

Journal ID (nlm-ta): Cancer Med

Journal ID (iso-abbrev): Cancer Med

Journal ID (doi): 10.1002/(ISSN)2045-7634

Journal ID (publisher-id): CAM4

Title: Cancer Medicine

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Electronic): 2045-7634

Publication date (Electronic): 22 January 2018

Publication date Collection: February 2018

Volume: 7

Issue: 2 ( doiID: 10.1002/cam4.2018.7.issue-2 )

Pages: 485-498

Affiliations

[ ¹ ] Division of Nephrology Department of Internal Medicine E‐DA Dachang Hospital/ I‐Shou University Kaohsiung Taiwan

[ ² ] School of Medicine for International Students E‐DA Hospital/ I‐Shou University Kaohsiung Taiwan

[ ³ ] Department of Neurosurgery E‐DA Hospital/ I‐Shou University Kaohsiung Taiwan

[ ⁴ ] Department of Medical Education E‐DA Hospital/ I‐Shou University Kaohsiung Taiwan

[ ⁵ ] Division of Nephrology Department of Internal Medicine National Cheng Kung University Hospital Tainan Taiwan

[ ⁶ ] Department of Pediatrics National Cheng Kung University Hospital Tainan Taiwan

[ ⁷ ] Institute of Clinical Medicine College of Medicine National Cheng Kung University Tainan Taiwan

[ ⁸ ] Biostatistics Consulting Center National Cheng Kung University Hospital Tainan Taiwan

[ ⁹ ] Department of Public Health College of Medicine National Cheng‐Kung University Tainan Taiwan

Author notes

[*] [* ] Correspondence

Sheng‐Hsiang Lin, Institute of Clinical Medicine, National Cheng Kung University Hospital, Medical College, No. 138, Sheng‐Li Road, Tainan City 701, Taiwan. Tel: +886 6 2353535 ext. 5962; Fax: +886‐6‐ 2758781; E‐mail: shlin922@ 123456mail.ncku.edu.tw

Yuan‐Yow Chiou and Sheng‐Hsiang Lin contributed equally as corresponding authors to this work

Author information

Yi‐Che Lee http://orcid.org/0000-0003-4931-0248

Article

Publisher ID: CAM41289

DOI: 10.1002/cam4.1289

PMC ID: 5806101

PubMed ID: 29356425

SO-VID: 8c40513f-18e8-46f3-a57d-f33aaee6ff27

License:

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Date received : 03 June 2017

Date revision received : 20 November 2017

Date accepted : 21 November 2017

Page count

Figures: 7, Tables: 5, Pages: 14, Words: 10372

Funding

Funded by: Research Foundation of E‐DA Hospital

Award ID: NCKUEDA10402

Award ID: EDAHP104010

Award ID: EDAHP105013

Funded by: National Cheng Kung University Hospital, Taiwan

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source-schema-version-number 2.0

component-id cam41289

cover-date February 2018

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.3.2.2 mode:remove_FC converted:09.02.2018

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: cancer,cohort study,dialysis,end‐stage renal disease,national health insurance

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ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: cancer, cohort study, dialysis, end‐stage renal disease, national health insurance

Is there different risk of cancer among end‐stage renal disease patients undergoing hemodialysis and peritoneal dialysis?

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Most cited references 45

Peritoneal dialysis and epithelial-to-mesenchymal transition of mesothelial cells.

Aristolochic acid nephropathy: a worldwide problem.

Cancer in patients on dialysis for end-stage renal disease: an international collaborative study.

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