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Abstract: TH-PO673

ESAs in Hemodialysis Patients With Malignancy: A Multicenter, Retrospective Cohort Study

Session Information

  • Anemia and Iron Metabolism
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism


  • Park, Junkyu, Catholic University of Korea School of Medicine, Seoul, Korea (the Republic of)
  • Chung, Sungjin, Catholic University of Korea School of Medicine, Seoul, Korea (the Republic of)
  • Koh, Eun Sil, Catholic University of Korea School of Medicine, Seoul, Korea (the Republic of)
  • Jo, Wonji, Catholic University of Korea School of Medicine, Seoul, Korea (the Republic of)

Anemia is a common complication in both chronic kidney disease (CKD) and malignancy, associated with mortality and decreased quality of life. Erythropoiesis-stimulating agents (ESAs) is commonly used to treat anemia in CKD patients. However, the risk of cancer progression of ESAs use has been constantly implicated. KDIGO guideline recommends to use ESAs with great caution for anemia in CKD patients combined with malignancy due to the risk of cancer progression. Recently, Several studies showed that it might be irrelevant. In this study, the impact of ESAs use on the risk of cancer progression and mortality has been explored.


A retrospective, multi-centered cohort was established using electronic medical records from 5 different medical institutes. Patients who were 18 years old or older, had been newly diagnosed end-stage renal disease and begun hemodialysis were considered as eligible participants. A total of 894 patients were enrolled from March 1, 2010 to December 31, 2017. The patients were classified into three groups based on ESAs prescription patterns: never users, dynamic users, and always users. The association between ESAs use and the occurrence of newly diagnosed malignancy, recurrence of pre-existing cancer, and mortality were investigated.


The mean age of the patients was 62 years and 58% were male. Diabetes consisted of 61.0% of the patients and 81.5% were hypertensive. The mean hemodialysis vintage was 6.9 years. Primary incidence of malignancy recurrence, newly diagnosed malignancy and mortality was 9 (1.9%), 52 (5.8%), 133 (14.9%), respectively. Multivariable cox regression analysis revealed that ESAs use is not significantly associated with mortality (Hazard ratio (HR), 0.55; Confidential index (CI), 0.19-1.52 ; P=0.246). The risk for newly diagnosed cancer decreased in always users compared with never users (HR, 0.12; CI, 0.02-0.67 ; P=0.016). The risk of newly diagnosed cancer for dynamic users were statistically insignificant compared with never users (HR, 0.23; CI, 0.05-1.08; P=0.063).


This study showed that there is no statistically significant difference in mortality risk among ESAs use patterns, and partially decreased risk for cancer progression. A careful, individualized administration of ESAs to patients with ESRD and malignancy can be considered for anemia treatment.