An Update on Hepatocellular Carcinoma in Chronic Kidney Disease

Abstract

Chronic kidney disease is a major public health issue globally and the risk of cancer (including HCC) is greater in patients on long-term dialysis and kidney transplant compared with the general population. According to an international study on 831,804 patients on long-term dialysis, the standardized incidence ratio for liver cancer was 1.2 (95% CI, 1.0–1.4) and 1.5 (95% CI, 1.3–1.7) in European and USA cohorts, respectively. It appears that important predictors of HCC in dialysis population are hepatotropic viruses (HBV and HCV) and cirrhosis. 1-, 3-, and 5-year survival rates are lower in HCC patients on long-term dialysis than those with HCC and intact kidneys. NAFLD is a metabolic disease with increasing prevalence worldwide and recent evidence shows that it is an important cause of liver-related and extra liver-related diseases (including HCC and CKD, respectively). Some longitudinal studies have shown that patients with chronic hepatitis B are aging and the frequency of comorbidities (such as HCC and CKD) is increasing over time in these patients; it has been suggested to connect these patients to an appropriate care earlier. Antiviral therapy of HBV and HCV plays a pivotal role in the management of HCC in CKD and some combinations of DAAs (elbasvir/grazoprevir, glecaprevir/pibrentasvir, sofosbuvir-based regimens) are now available for HCV positive patients and advanced chronic kidney disease. The interventional management of HCC includes liver resection. Some ablative techniques have been suggested for HCC in CKD patients who are not appropriate candidates to surgery. Transcatheter arterial chemoembolization has been proposed for HCC in patients who are not candidates to liver surgery due to comorbidities. The gold standard for early-stage HCC in patients with chronic liver disease and/or cirrhosis is still liver transplant.

Insights into induction of the immune response by the hepatitis B vaccine

“…These groups mainly include health care providers, illicit injected drug users, sexually active individuals (more than 1 partner in the past 6 mo), persons with diabetes, dialysis patients, and people living with human immunodeficiency virus (HIV). The last two groups, in addition to showing a higher risk of HBV infection compared to the general population[ 68 - 70 ] due to the frequent use of percutaneous materials and the common route of HBV and HIV transmission, have shown suboptimal responses to HBV immunization[ 71 , 72 ]. Patients on dialysis have also shown a diminished response to the HBV vaccine probably due to a uremic-associated suppression of the immune system that leads to a significant progressive reduction of the percentage and count of lymphocytes CD3+, CD4+, and CD8+ and a disturbance of antigen-presenting cells that results in an inability to sustain a satisfactory antibody titer over time[ 73 - 76 ].…”

“…Consequently, for patients on dialysis and/or living with HIV, other approaches are recommended to enhance the HBV vaccine immune response. For patients undergoing dialysis therapy, alternative strategies include the use of adjuvants, additional vaccination cycles, different vaccine formulations, greater number and concentration of doses, greater frequency of doses, dual vaccination, alternative administration routes, and/or use of booster vaccines[ 67 , 72 , 84 - 86 ]. On the other hand, for HIV-infected individuals with negative or < 10 mIU/mL anti-HBs levels after a primary vaccine series, a second HBV vaccine series using larger or additional doses is recommended[ 71 , 87 ].…”

Screening immune-related blood biomarkers for DKD-related HCC using machine learning

“…Moreover, about 50% of T2DM patients develop chronic kidney disease (CKD) ( 8 , 9 ). Patients with CKD appear to have a higher risk of developing HCC compared to the general population ( 10 ). Some studies show that the HCC patient population overlaps highly with the CKD patient population ( 11 ).…”

Statins Reduce Hepatocellular Carcinoma Risk in Patients with Chronic Kidney Disease and End-Stage Renal Disease: A 17-Year Longitudinal Study

“…In Taiwan, HCC is the most common form of cancer diagnosed among dialysis patients [6]. Studies have reported that dialysis patients with hepatitis B infection, hepatitis C infection and cirrhosis, non-alcoholic fatty liver disease (NAFLD), and alcoholic liver disease are at an increased risk of developing HCC [7][8][9][10]. In fact, a changing scenario of HCC risk factors emerged in recent years, with increasing proportions of HCC risk related to non-viral metabolic liver disease.…”