Incidence and spectrum of malignant disease among dialysis patients in North Bavaria

摘要

BACKGROUND AND OBJECTIVE: In end-stage renal failure the incidence of cancer is increased. With regard to frequency and pattern of distribution of the tumors, there are substantial regional differences. Since this topic has to date received only minimal attention in Germany, we undertook a multi-centric analysis (8 dialysis centres) in North Bavaria in order to address the occurrence of malignant diseases in end-stage renal failure. PATIENTS AND METHODS: Of a total of 2228 patients, who underwent hemodialysis in the period from 1990 - 99 as a consequence of end-stage renal failure, the medical records of 1727 persons were analysed. Only those patients were considered, whose malignancy was diagnosed in the course of the dialysis. The Saarland cancer register served as a comparative age- and sex-matched population, with which we calculated the expected frequency of the various cancers as well as the standard incidence ratio (SIR) for the dialysis patients. RESULTS: In total 125 malignant diseases were documented. The cancer incidence was highest in the first year of treatment and was clearly lower in the subsequent periods. Of great importance was the age of the patients. The highest SIR scores were found for patients of middle age (35 - 50 years). An enhanced risk for cancer of the kidney, bladder, prostate, liver, oral cavity and the pharynx and larynx, as well as of the lymphatic and hemopoetic systems was found, while there was no or only a slight increase in the frequency of carcinoma of the mammary gland, stomach, colon-sigma-rectum and bronchial systems. CONCLUSION: The high incidence of cancer in end-stage renal failure should be given greater attention. Particularly in the high-risk group of younger dialysis patients, a regular screening - especially for tumors of the kidney, bladder and liver - appears justified.