Login to Access Video or Poster Abstract: MP10-07
Sources of Funding: The study was supported in part by grants from the Shuang Ho Hospital, Taipei Medical University (102TMU-SHH-10) and Tung’s Taichung MetroHarbor Hospital (TTM-TMU-104-01).

Introduction

Chronic kidney disease (CKD) patients without effective treatment and follow-up usually progressed to end-stage renal disease (ESRD). Various therapeutic modalities including hemodialysis, peritoneal dialysis and renal transplantation are usually used to treat CKD patients. However, whether various therapeutic modalities can modify the risk of chronic diseases such as malignancies in CKD patients remains unclear. Therefore, the present study aims to investigate the association between therapeutic modalities of CKD patients and chronic diseases in Taiwan.

Methods

The National Health Insurance program was implemented since March 1995 by the National Health Insurance Administration, Ministry of Health and Welfare, with a coverage over 99% of 23 million people in Taiwan. The National Health Insurance Research Database (NHIRD) was released for research purposes. A total of 868 CKD patients who received renal transplantation (RT) and 54,243 non-CKD controls matched for age, gender and index date were recruited from the NHIRD. The CKD patients with RT was also confirmed by the registry of catastrophic illness. The cancer incidence was identified through cross-referencing with the Cancer Registry Database. Risks were estimated as hazard ratios (HRs) and their 95% confidence intervals (CIs) by using a Cox proportional hazards model.

Results

For CKD patients with RT, a significant higher incidence rate ratio (IRR) of all cancer sites (IRR = 3.79, 95% CI = 3.12-4.62) was found. After the adjustment for age, sex and co-morbidities, we also observed a significantly increased cancer risk of 3.87 (HR = 3.79, 95% CI = 3.16-4.73). Especially, we found that CKD patients with RT have a significant increased IRR of bladder cancer (IRR = 14.42, 95% CI = 8.09-25.67). A greatly increased bladder cancer risk (HR = 17.67, 95% CI = 9.64-32.38) was found for CKD patients with RT after the adjustment for age, sex and co-morbidities.

Conclusions

CKD patients have a higher risk of subsequent cancers, but the effect of therapeutic modalities such as RT on cancer risk is still unclear. Our finding is that CKD patients with RT have a significant increased risk of bladder cancer. Therefore, we should pay more attention to carry out effective treatments and implement an intensive follow-up to prevent CKD patients to progress to cancer.

Funding

The study was supported in part by grants from the Shuang Ho Hospital, Taipei Medical University (102TMU-SHH-10) and Tung’s Taichung MetroHarbor Hospital (TTM-TMU-104-01).