Overall and site-specific cancer mortality in patients on dialysis and after kidney transplant

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dc.contributor.authorAu, E.H.
dc.contributor.authorChapman, J.R.
dc.contributor.authorCraig, J.C.
dc.contributor.authorLim, W.H.
dc.contributor.authorTeixeira-Pinto, A.
dc.contributor.authorUllah, S.
dc.contributor.authorMcDonald, S.
dc.contributor.authorWong, G.
dc.date.issued2019
dc.description.abstractBackground: Patients with ESRD have a substantially increased cancer risk, but few studies have examined the patterns of cancer mortality along a patient's journey from dialysis to transplantation. Methods: We identified all Australian patients on dialysis and patients with transplants from 1980 to 2014 from the Australia and New Zealand Dialysis and Transplant Registry. Using standardized mortality ratios (SMRs), we compared cancer mortality among patients on dialysis and patients with transplants versus the general population (overall and by age, sex, year, and site); we also performed a subgroup analysis excluding patients with preexisting cancers. Results: We followed 52,936 patients on dialysis and 16,820 transplant recipients for 170,055 and 128,352 patient-years, respectively. There were 2739 cancer deaths among patients on dialysis and 923 cancer deaths among transplant recipients. Overall, cancer SMRs were 2.6 for patients on dialysis and 2.7 for transplant recipients. For patients on dialysis, SMRs were highest for multiple myeloma (30.5), testicular cancer (17.0), and kidney cancer (12.5); for transplant recipients, SMRs were highest for non-Hodgkin lymphoma (10.7), kidney cancer (7.8), and melanoma (5.8). Some 61.0% of patients on dialysis and 9.6% of transplant recipients who experienced cancer death had preexisting cancer. The SMRs for de novo cancer was 1.2 for patients on dialysis and 2.6 for transplant recipients. Conclusions: Patients on dialysis and transplant recipients experienced >2.5-fold increased risk of cancer death compared with the general population. This increased risk was largely driven by preexisting cancers in patients on dialysis and de novo cancers in patients with transplants.
dc.description.statementofresponsibilityEric H. Au, Jeremy R. Chapman, Jonathan C. Craig, Wai H. Lim, Armando Teixeira-Pinto, Shahid Ullah, Stephen McDonald, and Germaine Wong
dc.identifier.citationJournal of the American Society of Nephrology, 2019; 30(3):471-480
dc.identifier.doi10.1681/ASN.2018090906
dc.identifier.issn1046-6673
dc.identifier.issn1533-3450
dc.identifier.orcidUllah, S. [0000-0002-1825-7774] [0000-0003-0010-2640]
dc.identifier.orcidMcDonald, S. [0000-0001-6103-1386]
dc.identifier.urihttp://hdl.handle.net/2440/119540
dc.language.isoen
dc.publisherAmerican Society of Nephrology
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1092957
dc.rightsCopyright © 2019 by the American Society of Nephrology
dc.source.urihttps://doi.org/10.1681/asn.2018090906
dc.subjectCancer; nephrology
dc.titleOverall and site-specific cancer mortality in patients on dialysis and after kidney transplant
dc.typeJournal article
pubs.publication-statusPublished

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