#3243 Cancer Patients With End-Stage Kidney Disease on Chronic Hemodialysis: Changing the Paradigm

Abstract

Background and Aims In the last decade, new therapeutic regimens have dramatically improved the prognosis of cancer patients and changed the paradigm of a previously highly lethal disease, increasing the number of cancer patients with chronic kidney disease (CKD) who progress to end-stage kidney disease (ESKD). However decision-making regarding dialysis initiation in patients with cancer and ESKD remains however controversial. The aim of our study was to characterize the clinical course and evaluate survival outcomes of cancer patients on chronic hemodialysis (HD). Method We conducted a retrospective study of chronic HD patients in a single oncology hospital unit between January 1991 and November 2022. Outpatients on HD for more than one month, who underwent dialysis after the diagnosis of cancer were included. Univariate and multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality were estimated using the Cox proportional hazards risk model. Results Two hundred and twelve patients were recruited. Mean age at HD initiation was 65.7±14.7 years. The most prevalent ESKD etiologies were cast nephropathy, chronic interstitial nephritis, and surgical removal of the kidney. The most common tumors were genitourinary, multiple myeloma (MM) and gastrointestinal corresponding to 80.6% of all cancers. There were 143 deaths over a median follow-up period of 23 months (IQR: 7.25 – 54). The overall survival rates were 76.5% at 1 year, 59.6% at 3 years and 39.2% at 5 years. The median survival time was 44 months (95% CI: 30.58 – 51.42). An increased mortality risk was observed in patients with MM (HR: 3.38; 95% CI: 1.01-11.39; p = 0.045) and in those who started HD from 2001 to 2011 (HR: 1.60; 95% CI: 1.06-2.42; p = 0.001). The presence of metastasis or multiple tumors was not associated with all-cause mortality. Conclusion Our results highlight the importance of considering cancer patients for renal support therapies, including those with multiple tumors and metastatic disease. In fact, with the new treatments available, many patients have chronic oncological disease non-fatal in the short term. To the best of our knowledge, this is the largest study of cancer patients on chronic HD.