E AU1, J CHAPMAN1, J CRAIG2,3, W LIM4, A TEIXEIRA-PINTO3,S ULLAH5, S MCDONALD5,6, G WONG1,2,3
1Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales; 2Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales; 3School of Public Health, University of Sydney, Sydney, New South Wales; 4Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia; 5Australian and New Zealand Dialysis and Transplant Registry; 6Central
and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia
Aim: To compare the rates of overall and site-speciﬁc cancer mortality in the dialysis and transplant populations with the age and gender matched general population.
Background: After cardiovascular disease, cancer is a major cause of mortality in dialysis and transplant patients. However, the comparative rates of cancer related mortality between the general population and those with endstage kidney disease (ESKD) may differ between cancer sites and types of renal replacement therapies. Methods: We included dialysis and transplant patients who commenced renal replacement therapies between 1980 and 2014 from the ANZDATA Registry. Cancer mortality for different cancer types were compared with the general population using standardized mortality ratios (SMR).
Results: A total of 52,936 dialysis patients (59.0% male) and 16,820 transplant recipients (60.4% male) were identiﬁed and followed for 318,090 and 162,537 patient-years respectively. There were 2739 cancer deaths in the dialysis population (5.2%) and 923 in the transplant population (5.5%). The median age at cancer death was 70 (interquartile range (IQR) 63-76) and 62 (IQR 55-68) years for dialysis and transplant patients, respectively. The overall cancer SMRs were 1.9 (95% CI:1.8-2.0) for dialysis and 2.3 (95% CI:2.1-2.4) for transplant patients. In dialysis patients, the highest SMRs were seen in multiple myeloma [22.6 (95% CI:20.8-24.4)], kidney cancer [9.0 (95% CI:7.9-10.1)] and bladder cancer [3.9 (95% CI:3.3-4.6)]. For transplant recipients, the highest SMRs were observed for non-Hodgkin lymphoma [9.4 (95% CI:7.9-11.2)], kidney cancer [9.2 (95% CI:4.9-8.3)] and melanoma [4.7 (95% CI:3.7-6.0)].
Conclusions: Dialysis and transplant patients experienced at least a one and two-fold increased risk of cancer mortality compared to the general population. The magnitude of the increased risk varied between cancer types.