Dialysis-related practice patterns among hemodialysis patients with cancer

Health Sci Rep. 2018 May 16;1(7):e46. doi: 10.1002/hsr2.46. eCollection 2018 Jul.


Rationale aims and objectives: With the achievement of longevity in hemodialysis patients, the risk of comorbid cancer has begun to draw attention. In the present study, we examined dialysis-related practice patterns and compared those patterns by cancer status.

Methods: Using data from the Japan Dialysis Outcomes and Practice Patterns Study phase 4, we evaluated 2153 hemodialysis patients. Baseline cancer status for patients was separated into 3 categories: no cancer, cancer with recent treatment, and cancer without recent treatment. We then assessed variations among hemodialysis patients in dialysis-related practice patterns, including anemia management, management of mineral and bone metabolism disorder, nutritional management, and dialysis treatment, by cancer status.

Results: We observed both similarities and differences in dialysis-related practice patterns among hemodialysis patients, by cancer status. Hemoglobin levels were largely similar for all cancer statuses, although erythropoiesis stimulating agents dose tended to be higher in hemodialysis patients with recent cancer treatment (multivariable adjusted mean difference of erythropoiesis stimulating agents dose: 5.4 × 103 IU/L/month) than in those without cancer. Phosphorus and calcium levels were also similar. Nutrition statuses were similar among cancer statuses, as were dialysis therapies. These results suggested that physicians do not modulate their dialysis-related practices based on whether or not a hemodialysis patient has cancer.

Conclusion: Among long-term facility-based hemodialysis patients with cancer, we detected no statistically significant differences to suggest that cancer status affects hemodialysis practice regarding mineral and bone disorder management, nutritional management, and dialysis treatment. Facility-based hemodialysis patients with recent cancer treatment, however, receive a higher dose of erythropoietin-stimulating agent than those without cancer.

Keywords: CKD‐MBD; erythropoiesis; hemodialysis; neoplasms; practice patterns; renal anemia.