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Clinical Epidemiology
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Variation in Cancer Incidence among Patients with ESRD during Kidney Function and Nonfunction Intervals

Elizabeth L. Yanik, Christina A. Clarke, Jon J. Snyder, Ruth M. Pfeiffer and Eric A. Engels
JASN May 2016, 27 (5) 1495-1504; DOI: https://doi.org/10.1681/ASN.2015040373
Elizabeth L. Yanik
*Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland;
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Christina A. Clarke
†Cancer Prevention Institute of California, Fremont, California;
‡Department of Health Research and Policy, Stanford University School of Medicine and Stanford Cancer Institute, Palo Alto, California;
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Jon J. Snyder
§Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota; and
‖Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
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Ruth M. Pfeiffer
*Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland;
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Eric A. Engels
*Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland;
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Abstract

Among patients with ESRD, cancer risk is affected by kidney dysfunction and by immunosuppression after transplant. Assessing patterns across periods of dialysis and kidney transplantation may inform cancer etiology. We evaluated 202,195 kidney transplant candidates and recipients from a linkage between the Scientific Registry of Transplant Recipients and cancer registries, and compared incidence in kidney function intervals (time with a transplant) with incidence in nonfunction intervals (waitlist or time after transplant failure), adjusting for demographic factors. Incidence of infection-related and immune-related cancer was higher during kidney function intervals than during nonfunction intervals. Incidence was most elevated for Kaposi sarcoma (hazard ratio [HR], 9.1; 95% confidence interval (95% CI), 4.7 to 18), non-Hodgkin’s lymphoma (HR, 3.2; 95% CI, 2.8 to 3.7), Hodgkin’s lymphoma (HR, 3.0; 95% CI, 1.7 to 5.3), lip cancer (HR, 3.4; 95% CI, 2.0 to 6.0), and nonepithelial skin cancers (HR, 3.8; 95% CI, 2.5 to 5.8). Conversely, ESRD-related cancer incidence was lower during kidney function intervals (kidney cancer: HR, 0.8; 95% CI, 0.7 to 0.8 and thyroid cancer: HR, 0.7; 95% CI, 0.6 to 0.8). With each successive interval, incidence changed in alternating directions for non-Hodgkin’s lymphoma, melanoma, and lung, pancreatic, and nonepithelial skin cancers (higher during function intervals), and kidney and thyroid cancers (higher during nonfunction intervals). For many cancers, incidence remained higher than in the general population across all intervals. These data indicate strong short-term effects of kidney dysfunction and immunosuppression on cancer incidence in patients with ESRD, suggesting a need for persistent cancer screening and prevention.

  • cancer
  • epidemiology and outcomes
  • kidney transplantation
  • dialysis
  • Copyright © 2016 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 27 (5)
Journal of the American Society of Nephrology
Vol. 27, Issue 5
May 2016
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Variation in Cancer Incidence among Patients with ESRD during Kidney Function and Nonfunction Intervals
Elizabeth L. Yanik, Christina A. Clarke, Jon J. Snyder, Ruth M. Pfeiffer, Eric A. Engels
JASN May 2016, 27 (5) 1495-1504; DOI: 10.1681/ASN.2015040373

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Variation in Cancer Incidence among Patients with ESRD during Kidney Function and Nonfunction Intervals
Elizabeth L. Yanik, Christina A. Clarke, Jon J. Snyder, Ruth M. Pfeiffer, Eric A. Engels
JASN May 2016, 27 (5) 1495-1504; DOI: 10.1681/ASN.2015040373
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  • cancer
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  • kidney transplantation
  • dialysis

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