Dialysis‐related practice patterns among hemodialysis patients with cancer

Abstract

Rationale, aims, and objectivesWith the achievement of longevity in hemodialysis patients, the risk of comorbid cancer has begun to draw attention. In the present study, we examined dialysis‐related practice patterns and compared those patterns by cancer status.MethodsUsing data from the Japan Dialysis Outcomes and Practice Patterns Study phase 4, we evaluated 2153 hemodialysis patients. Baseline cancer status for patients was separated into 3 categories: no cancer, cancer with recent treatment, and cancer without recent treatment. We then assessed variations among hemodialysis patients in dialysis‐related practice patterns, including anemia management, management of mineral and bone metabolism disorder, nutritional management, and dialysis treatment, by cancer status.ResultsWe observed both similarities and differences in dialysis‐related practice patterns among hemodialysis patients, by cancer status. Hemoglobin levels were largely similar for all cancer statuses, although erythropoiesis stimulating agents dose tended to be higher in hemodialysis patients with recent cancer treatment (multivariable adjusted mean difference of erythropoiesis stimulating agents dose: 5.4 × 103 IU/L/month) than in those without cancer. Phosphorus and calcium levels were also similar. Nutrition statuses were similar among cancer statuses, as were dialysis therapies. These results suggested that physicians do not modulate their dialysis‐related practices based on whether or not a hemodialysis patient has cancer.ConclusionAmong long‐term facility‐based hemodialysis patients with cancer, we detected no statistically significant differences to suggest that cancer status affects hemodialysis practice regarding mineral and bone disorder management, nutritional management, and dialysis treatment. Facility‐based hemodialysis patients with recent cancer treatment, however, receive a higher dose of erythropoietin‐stimulating agent than those without cancer.

Treatment of anemia in difficult-to-manage patients with chronic kidney disease

“…54 Despite these recommendations, real-world studies suggest that the use of ESA and iron is common among patients with ESKD and cancer, with dosing trends being similar to or higher than those observed among patients on hemodialysis without cancer. 55,56 In a US study of patients on hemodialysis with a cancer diagnosis, quarterly ESA use ranged from 94.1% of patients in 2002 to 90.0% in 2011, whereas epoetin alfa use decreased between 2002 (94.1%) and 2007 (85.4%) and remained stable thereafter. 55 In this study, monthly mean epoetin alfa doses initially increased from 66,000 to 83,000 IU between 2001 and 2004, then decreased to 52,000 IU by 2011, and were higher in patients with hematologic cancer than in those with solid tumors.…”

“…55 A Japanese study of patients on hemodialysis also found that mean ESA doses were higher in those with cancer versus those without cancer (adjusted mean difference, 5.4 Â 10 3 IU/l/mo). 56 In our experience, the management of anemia in patients with ESKD and a history of cancer must weigh the risks of treatment against the alternative of chronic anemia and/or frequent RBC transfusions.…”