CANCER MORTALITY IN PEOPLE ON DIALYSIS IN AUSTRALIA AND NEW ZEALAND: A NATIONAL COHORT STUDY FROM 1980 TO 2013

B ROSALES1, N DE LA MATA1, P KELLY1, AC WEBSTER1,2,3
1Sydney School of Public Health, University of Sydney, , , 2Centre for Kidney Research, Sydney, NSW, , , 3Westmead Hospital, Sydney, NSW,

Aim: To compare all-site and site-specific cancer mortality between people on dialysis for end-stage kidney disease (ESKD) and the general population in Australia and New Zealand.
Background: Cancer remains a significant predictor of mortality in people on dialysis. However, people on dialysis are also at increased risk of death from other diseases. The relative risk of cancer death and any changes in cancer mortality over time are not clear.
Methods: We conducted a population-based cohort study, using ANZDATA linked with Australian and New Zealand death registries, in incident kidney transplant recipients from 1980-2013. Cancers were categorised using ICD-10-AM codes. Standardised mortality ratios (SMR) were estimated using indirect standardisation.
Results: We included 59,173 people on dialysis with 206,851 person-years (pys) of follow-up. Of 28,952 deaths, 2,640 (4.34%) were from cancer. All-site cancer mortality was 1,276 per 100,000 pys (95%CI 1229-1326), and higher in men (1474 per 100, 000 pys; 95%CI 1406-1545). People on dialysis were >2 times more likely to die cancer deaths (SMR 2.1; 95%CI 2.0-2.2) compared to the general population. All-site cancer mortality increased significantly with age in both men and women (p<0.001). The relative risk of cancer death (SMR) decreased as age increased in both men and women (p<0.001). Women were at higher risk of cancer mortality (SMR 2.4; 95%CI 2.28-2.59) than men (SMR 1.9; 1.85-2.03). Overall, all-site cancer deaths increased over time since 1980 (p<0.001), however SMRs have decreased over time (p=0.001).
Conclusions: People on dialysis are at increased risk of cancer death. Cancer mortality has increased over time, however the relative risk of cancer death, while still elevated over the general population, has decreased over time.


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