Mortality from cancer among US hemodialysis patients, 1995-2005

Background/Aims: Concern has emerged that erythropoiesis-stimulating agents (ESAs) may decrease survival for cancer patients; many patients beginning dialysis have previous cancer diagnoses. As ESA doses have more than tripled in the USA since ESAs were introduced, we aimed to compare annual trends in cancer-specific mortality rates among incident maintenance hemodialysis patients. Methods: This national, retrospective, incident cohort study included 873,493 patients aged ≥20 years who initiated hemodialysis between 1995 and 2005. Cancer-specific mortality rates were adjusted for baseline characteristics, determined from the Centers for Medicare & Medicaid Services (CMS) Medical Evidence Report (form CMS-2728). Follow-up extended to December 31, 2006. Cause of death was ascertained from the Death Notification (form CMS-2746). Results: Crude first-year cancer-specific mortality rates, per 1,000 patient-years, 1995-2005, were as follows: 13.8, 13.7, 14.2, 14.9, 13.8, 15.4, 15.4, 16.5, 16.4, 15.8, 15.2. Mortality rates remained stable year to year within subsequent follow-up intervals; for the first and last annual cohorts, mortality rates by follow-up interval were: year 2, 9.1 and 8.7; year 3, 8.6 and 8.3; years 4-5, 7.9 and 6.8. Annual comparisons were similar after adjustment for patient characteristics at dialysis initiation. Conclusion: Cancer-specific mortality rates remained stable among US hemodialysis patients between 1995 and 2005.