Background:The overall incidence of malignancy in patients with end-stage kidney disease (ESKD) is reportedly higher compared to the general population. Cancer remains one of the dominant causes of death in these patients, due in part to uremia-induced impairment of tumor immune surveillance. Malignancy is one of the major limitations in the evaluation of potential kidney transplantation. This study aimed to assess the prevalence of cancer in hemodialysis population, particularly in relation to the waiting list.Materials and Methods:From the population of 5879 prevalent hemodialysis patients (60% men), 757 of them had a history of malignancy. In this population, 449 patients were actively waitlisted, and 4619 were not considered for potential kidney transplantation. Only 54 patients had unclear status in relation to active waiting list (during evaluation/disqualification). We assessed demographic data, basal biochemical data, and comorbidities, including malignancy, in relation to age, sex, presence of metastasis, and being actively waitlisted.Results:Malignancy was reported in 13% of hemodialysis patients, 6% of which had metastatic disease. Patients with malignancy were older (p< 0.001). More cases of cancer were observed in males (p= 0.02), who also had higher Charlson Comorbidity Index scores. Moreover, in patients with cancer, cardiovascular diseases were more common. They were also more malnourished (lower albumin, hemoglobin, lean mass) and more inflamed (higher ferritin, lower phosphorus). Only 27 patients with cancer were actively waitlisted, representing only 3.8% of this population. Patients with prior cancer on the active waiting list constituted 6% of all the waitlisted patients. Patients with a history of malignancy on the active waiting list were significantly younger, healthier, with significantly lower Charlson Comorbidity Index score, significantly lower ferritin, lower prevalence of diabetes, and higher blood pressure when compared to patients with malignancy who not listed for kidney transplantation.Conclusions:As malignancy became a more common comorbidity in dialysis patients, the elderly in particular, standardized cancer screening protocols should be promoted in dialysis units. Modern oncology has made huge progress, enabling the treatment of previously incurable cancers, as malignancy after kidney transplantation is considerably increased either due to de novo cancers or the recurrence of previous malignancy. Therefore, the evaluation of potential kidney transplant recipients, with tailored cancer screening and multidisciplinary evaluation, is strongly recommended. Besides a history of malignancy, the cardiovascular status also determines the eligibility for transplantation in dialysis patients. It is of paramount importance as the main cause of death in transplant recipients is cardiovascular death followed by malignancy.
背景：据报道，终末期肾病（ESKD）患者的总体恶性肿瘤发病率高于普通人群。癌症仍是这些患者的主要死因之一，部分原因是尿毒症导致的肿瘤免疫监视功能受损。恶性肿瘤是评估潜在肾移植可行性的主要限制因素之一。本研究旨在评估血液透析人群中癌症的患病率，特别是与移植等待名单相关的情况。 材料与方法：在5879名长期血液透析患者（60%为男性）中，757人有恶性肿瘤病史。在这部分人群中，449名患者被积极列入等待名单，4619名患者未被考虑进行潜在的肾移植。仅有54名患者与积极等待名单相关的状态不明确（处于评估/取消资格阶段）。我们评估了人口统计学数据、基础生化数据和合并症（包括恶性肿瘤），并分析了其与年龄、性别、是否存在转移以及是否被积极列入等待名单的关系。 结果：血液透析患者中恶性肿瘤的患病率为13%，其中6%为转移性疾病。恶性肿瘤患者年龄更大（p<0.001）。男性中观察到更多癌症病例（p=0.02），其查尔森合并症指数评分也更高。此外，癌症患者中心血管疾病更为常见。他们还表现出更严重的营养不良（白蛋白、血红蛋白、瘦体重较低）和更高的炎症水平（铁蛋白较高、血磷较低）。仅有27名癌症患者被积极列入等待名单，仅占该人群的3.8%。有既往癌症史的积极等待名单患者占所有等待名单患者的6%。与未列入肾移植名单的恶性肿瘤患者相比，积极等待名单上有恶性肿瘤史的患者明显更年轻、更健康，查尔森合并症指数评分显著更低，铁蛋白水平显著更低，糖尿病患病率更低，血压更高。 结论：随着恶性肿瘤成为透析患者（尤其是老年患者）中更常见的合并症，应在透析单元推广标准化的癌症筛查方案。现代肿瘤学已取得巨大进展，使得治疗以往无法治愈的癌症成为可能，因为肾移植后恶性肿瘤发病率显著增加，无论是由于新发癌症还是既往恶性肿瘤的复发。因此，强烈建议对潜在的肾移植受者进行评估，包括量身定制的癌症筛查和多学科评估。除了恶性肿瘤病史外，心血管状况也是决定透析患者移植资格的关键因素。这一点至关重要，因为移植受者的主要死因是心血管死亡，其次是恶性肿瘤。
肿瘤(癌症)患者之家