Association of erythropoiesis-stimulating agents and the incidence risk of cancer diagnosis among chronic dialysis patients: a nested case–control study

René, Émilie; Lazrak, H.; Laurin, Louis-Philippe; Elftouh, Naoual; Vallée, Michel; Lafrance, Jean‐Philippe

doi:10.1093/ndt/gfw268

Cited by 10 publications

(17 citation statements)

References 29 publications

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“…The use of erythropoietin may be the consequence of cancer. To avoid this reverse causality, the use of erythropoietin in the 6 months prior to the first diagnosis of cancer was not considered [21]. Therefore, the exposure to erythropoietin was calculated from dialysis initiation to 6 months before either first cancer diagnosis or the last day of follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the exposure to erythropoietin was calculated from dialysis initiation to 6 months before either first cancer diagnosis or the last day of follow-up. All enrolled patients used recombinant human erythropoietin injection only, and the average dosage was categorized into a low dose (< 20,000 U/week) and high dose (≥20,000 U/week) [21][22][23].…”

Section: Discussionmentioning

confidence: 99%

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Incidence, Risk, and Prognosis of Cancer in Patients on Chronic Hemodialysis

et al. 2019

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Background: Information concerning the cancer issue in Chinese patients on hemodialysis (HD) was lacking. Thus, we examined data from our dialysis registry to investigate the incidence of cancer, identify the possible factors, and explore outcomes after cancer diagnosis in patients on chronic HD. Methods: A retrospective cohort study of 639 newonset end-stage renal disease patients who started HD therapy during the period from July 1999 to December 2017 was retrieved from the database in our dialysis center. All eligible patients were followed up until renal transplantation, death, or end of study (March 31, 2019). The definition of a newly diagnosed cancer was that diagnosed 6 months after HD therapy initiation. Results: Within a median follow-up period of 5.61 years, 58 patients (9.08%) have been diagnosed with cancer with the incidence of 1,494 per 10 5 person-years. The mean duration from HD initiation to cancer diagnosis was 5.22 ± 3.55 years. Digestive cancer (32.76%) was the most common followed by urologic cancer (18.97%) and lung cancer (15.52%). Advanced age at starting HD therapy (hazard ratio [HR] 1.04) and erythropoietin dosage ≥20,000 U/week (HR 1.95) were independent predictors for cancer occurrence. Of the 256 deaths during the follow-up period, 29 cases (11.33%) were attributed to cancer, with the mortality rate of 717 per 10 5 person-years. The 1-, 5-, and 10-year cumulative survival rates after cancer diagnosis were 58.73, 34.64, and 20.41%, respectively. A total of 32 patients (55.17%) did not receive any anti-cancer therapy, and the mortality in those patients was significantly increased as compared to patients who received anti-cancer therapy. Conclusion: Cancer is common in HD patients due to the improved survival, and it has a negative effect on patient prognosis. Many patients have failed to receive optimal anti-cancer therapy, which calls for effective communication and cooperation among patients, dialysis unit, and oncology teams.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence, Risk, and Prognosis of Cancer in Patients on Chronic Hemodialysis

et al. 2019

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“…A meta‐analyses of ESA trials in CKD patients revealed that higher Hg targets were associated with increased risk for stroke, hypertension, and vascular access thrombosis across all stages of CKD . ESA use also corresponded with a higher odds ratio (OR) for developing a new cancer, and in patients with cancer, ESA use correlated with tumor growth, shorter progression‐free survival (PFS), and an increased risk of mortality …”

Section: Summary Of the American Society Of Clinical Oncology/americamentioning

confidence: 99%

Anemia management in cancer patients with chronic kidney disease

Latcha

2019

Seminars in Dialysis

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Cancer and kidney disease are linked by causality and comorbidities. Observational data show an increased risk of malignancy as renal function declines. Erythropoietin stimulating agents (ESAs), which are the cornerstone therapy for anemia patients with chronic kidney disease and cancer, are associated with increased risks for cancer, cancer‐related mortality, progression of disease, and thromboembolic events. This article examines the recently published guidelines for ESA use in cancer patients from the American Society of Clinical Oncology and American Society of Hematology and attempts to contextualize them to the care of patients with coexistent CKD, cancer, and anemia.

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“…It is important to point out that CKD patients also present high cancer incidence, although it is not well‐known if this pathology is cause or consequence [Stengel, ]. Nevertheless, the dialysis process has been associated with increased cancer risk [Lin et al, ] and, more recently, the use of erythropoiesis‐stimulating agents in CKD patients has also been associated with increased incidence of cancer [René et al, ].…”

Section: Introductionmentioning

confidence: 99%

DNA damage in kidney transplant patients. Role of organ origin

Corredor

Rodríguez-Ribera

Coll

et al. 2017

Environ and Mol Mutagen

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Chronic kidney disease (CKD) patients are characterized by elevated levels of genomic damage. This damage increases when kidney function decreases being maximum in hemodialysis patients. As kidney transplantation improves renal function, and it is related with better survival, the aim of our study was to evaluate potential changes in DNA damage levels after kidney transplantation, and comparing living donor recipients with cadaveric donor recipients. The alkaline comet assay was used to determine DNA breaks and oxidative damaged DNA; and the micronucleus assay was used to determine chromosomal breakage and/or aneuploidy. Fifty CKD patients were followed up after 6 and 12 months of their kidney transplantation. All patients increased their genomic damage levels after 6 and 12 months of renal transplantation, compared with those observed before transplantation, despite of the improvement of their metabolic functions. Donor advanced age correlated positively with higher DNA damage. Genomic damage was lower in living donor transplants with respect to cadaveric donor transplants. Our conclusion is that DNA damage increased in kidney transplantation patients, whereas their renal function improved. Higher levels of DNA damage were found in cadaveric donor transplants when compared to living donor transplants. Environ. Mol. Mutagen. 58:712-718, 2017. © 2017 Wiley Periodicals, Inc.

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Association of erythropoiesis-stimulating agents and the incidence risk of cancer diagnosis among chronic dialysis patients: a nested case–control study

Abstract: High-dose ESA was associated with an increased incidence risk of new cancer diagnosis among chronic dialysis patients.

Cited by 10 publications

References 29 publications

Incidence, Risk, and Prognosis of Cancer in Patients on Chronic Hemodialysis

Incidence, Risk, and Prognosis of Cancer in Patients on Chronic Hemodialysis

Anemia management in cancer patients with chronic kidney disease

DNA damage in kidney transplant patients. Role of organ origin

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