In-hospital mortality associated with transcatheter arterial embolization for treatment of hepatocellular carcinoma in patients on hemodialysis for end stage renal disease: a matched-pair cohort study using a nationwide database

Abstract

Objectives: No previous study has evaluated the risks associated with transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma in patients on hemodialysis (HD) for end stage renal disease (ESRD), because invasive treatment is rarely performed for such patients. We used a nationwide database to investigate in-hospital mortality and complication rates following TACE in patients on HD for ESRD. Methods: Using the Japanese Diagnosis Procedure Combination database, we enrolled patients on HD for ESRD who underwent TACE for hepatocellular carcinoma. For each patient, we randomly selected up to four non-dialyzed patients using a matched-pair sampling method based on the patient’s age, sex, treatment hospital, and treatment year. In-hospital mortality and complication rates were compared between dialyzed and non-dialyzed patients following TACE. Results: We compared matched pairs of 1551 dialyzed and 5585 non-dialyzed patients. Although the complication rate did not differ between the dialyzed and non-dialyzed ESRD patients [5.7% vs 5.8%, respectively; odds ratio, 0.99; 95% confidence interval (0.79–1.23); p = 0.90], the in-hospital mortality rate was significantly higher in dialyzed ESRD patients than in non-dialyzed patients [2.2% vs 0.97%, respectively; odds ratio, 2.21; 95% confidence interval (1.44–3.40); p < 0.001]. Among the dialyzed patients, the mortality rate was not significantly associated with sex, age, Charlson comorbidity index, or hospital volume. Conclusions: The in-hospital mortality rate following TACE was 2.2 % and was significantly higher in dialyzed than in non-dialyzed ESRD patients. The indications for TACE in HD-dependent patients should be considered carefully with respect to the therapeutic benefits vs risks. Advances in knowledge: In hospital mortality rate following TACE in dialyzed patients was more than twice compared to non-dialyzed patients. Post-procedural complication following TAE in ESRD onHD patients was 5.7%, and did not differ from that in non dialyzed patients.

Hepatocellular carcinoma in patients with renal dysfunction: Pathophysiology, prognosis, and treatment challenges

“…For patients already on regular hemodialysis for ESRD at the time of TACE, data are lacking because invasive treatment is rarely performed in this specific population. A Japanese pair-matched cohort using a nationwide database was recruited to evaluate the in-hospital mortality and complication rates following TACE in this population[ 209 ]. A total of 1551 dialyzed and 5585 nondialyzed patients with ESRD were enrolled.…”