Death Does Matter-Cancer Risk in Patients With End-Stage Renal Disease A Nationwide Population-Based Study With Competing Risk Analyses

doi:10.1097/MD.0000000000002512

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Title:	Death Does Matter-Cancer Risk in Patients With End-Stage Renal Disease A Nationwide Population-Based Study With Competing Risk Analyses
Authors:	Weng, Shih-Feng Chiu, Yu-Hsien Jan, Ren-Long Chen, Yi-Chen Chien, Chih-Chiang Wang, Jhi-Joung Chu, Chin-Chen
Contributors:	Kaohsiung Med Univ, Dept Healthcare Adm & Med Informat Chi Mei Med Ctr, Dept Pediat Natl Cheng Kung Univ, Grad Inst Clin Med Chi Mei Med Ctr, Dept Med Res Chi Mei Med Ctr, Dept Nephrol Chung Hwa Univ Med Technol, Dept Food Nutr Chi Mei Med Ctr, Dept Anesthesiol Chia Nan Univ Pharm & Sci, Dept Recreat & Hlth Care Management
Keywords:	chronic dialysis patients hepatocellular-carcinoma urinary-tract hepatitis-b taiwan transplantation hemodialysis infections regression mortality
Date:	2016-01
Issue Date:	2018-01-18 11:41:31 (UTC+8)
Publisher:	Lippincott Williams & Wilkins
Abstract:	Patients with end-stage renal disease (ESRD) have a high mortality rate. We hypothesized that not accounting for death as a competing risk overestimates the event rate caused by ESRD. Thus, we examined the cancer risk for patients with ESRD (ESRDPos) after death as a competing risk event had been adjusted for. Patients with newly diagnosed ESRD (n = 64,299) between 1999 and 2007, together with age- and sex-matched controls without ESRD (ESRDNeg) (n = 128,592) were enrolled (1:2). In a Cox proportional hazards model that included death as a competing risk, ESRDPos patients in Taiwan had a lower overall incidence (subdistribution hazard ratio [sdHR] = 1.29) of cancer than did ESRDNeg patients in a Cox model that did not include death as a competing risk (HR = 1.70). After competing mortality had been adjusted for, ESRDPos patients >= 70 (sdHR = 0.82) and ESRDPos patients on long-term dialysis (> 5 follow-up years, sdHR = 0.62), had a lower risk for developing cancer than did ESRDNeg patients. This finding supported our hypothesis that standard survival analyses overestimate the event rate, especially when the mortality rate is high. It also showed that ESRDPos patients, when they grow older, were far less likely to develop cancer and far more likely to die because of underlying illnesses that might also affect the risk of death because of ESRD.
Relation:	Medicine, v.95 n.3, e2512
Appears in Collections:	[Dept. of Recreation and Health-Care Management] Periodical Articles

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