ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-PO566

Cancer Screening in ESRD Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Sundararajan, Anusha, Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut, United States
  • Kana kadayakkara, Deepak, Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut, United States
  • Buller, Gregory K., Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut, United States
Background

As primary care physicians, we order health maintenance investigations as part of preventive work up which include cancer screening tests. ESRD patients form a special subset of population where regular cancer screening guidelines should not be applied as mortality is higher. The 2012 ASN ‘choosing wisely’ campaign recommended against regular cancer screening in ESRD patients. We initiated a project in our institution to assess the frequency of cancer screening tests- with focus on colorectal cancer screening in our ESRD population.

Methods

We did a retrospective study which included ESRD patients on hemodialysis ( based on ICD codes) from a single center from 2012-2017 and excluded patients who had already received transplant or had prior malignancy. We had a total of 298 patients.

Results

Among the total 298 patients, 188 patients were between 45-75 year age group- out of which 96 patients (51%) underwent colonoscopy; out of 96 patients who underwent colonoscopy, 36 (37.5 %) were not transplant candidates and 16 (16.6%) died within the next 5 years. We also calculated Charlson comorbidity index of the patients to assess their 10 year survival likelihood.

Conclusion

Although patients who were undergoing transplant evaluation and patients with higher life expectancy had higher screening probability, the above numbers suggest that overscreening is still present. Hence, more individualized decision making including transplant likelihood and overall comorbidities of patients have to be considered before ordering cancer screening tests to avoid unnecessary cost and patient burden. These results can also help modify current practice- Providers can be alerted by EMR in ESRD population before ordering cancer screening tests to check if they will really benefit from them.