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Abstract: FR-PO810

Comparison of All-Cause Mortality Between Maintenance Dialysis and Cancer Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Naylor, Kyla Lynn, University of Toronto, Toronto, Ontario, Canada
  • Kim, Joseph, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
  • McArthur, Eric, Institute for Clinical Evaluative Sciences, London, Ontario, Canada
  • Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada
  • Knoll, Greg A., Ottawa Hospital, Ottawa, Ontario, Canada
Background

Mortality risk is high in dialysis patients. Yet, the mortality risk in dialysis compared to other diseases like cancer is poorly understood. We conducted a population-based cohort study using healthcare databases from Ontario, Canada, to examine survival probabilities for all-cause mortality in maintenance dialysis patients compared to patients with common cancers (women: breast, colorectal, lung, or pancreas; men: prostate, colorectal, lung, or pancreas) from 1997 to 2015.

Methods

We used the Kaplan-Meier product limit estimator to determine the cumulative probability of survival for all-cause mortality. Additional analyses examined the risk of mortality adjusting for clinical characteristics and trends in survival probability using Cox proportional hazards regression.

Results

33,500 maintenance dialysis patients and 532,452 cancer patients (median follow-up 4.4 years). In males, dialysis had worse 5-year survival (50.8%, 95% confidence interval [CI]: 50.1, 51.6%) compared to prostate (83.3%, 95% CI: 83.1, 83.5%) and colorectal cancer (56.1%, 95% CI: 55.7, 56.5%) but better survival than lung (14.0%, 95% CI: 13.7, 14.3%) and pancreas cancer (9.1%, 95% CI: 8.5, 9.7%). In females, dialysis had worse 5-year survival (49.8%, 95% CI: 48.9, 50.7%) compared to breast (82.1%, 95% CI: 81.9, 82.4%) and colorectal cancer (56.8%, 95% CI: 56.3, 57.2%) but better survival than lung (19.7%, 95% CI: 19.4, 20.1%) and pancreas cancer (9.4%, 95% CI: 8.9, 10.0%). After adjusting for clinical characteristics, similar results were found. Survival significantly improved across eras (1997-2001, 2002-2006, 2007-2011, 2012-2015) for all cancer types (P<0.01) but no significant change was observed in dialysis patients (females, P=0.89; males, P=0.48) (Figure).

Conclusion

Survival in dialysis patients was lower than patients with several types of common cancers. Unlike cancer patients, the prognosis of patients on dialysis has not improved over time. Results highlight the need to develop and test interventions to improve survival in maintenance dialysis patients.

Figure. 5-year survival probabilities for all-cause mortality by era of cohort entry for women (A) and men (B)