Incidence of major urological cancers in patients on dialysis: a systematic review and meta-analysis.

Abstract

Background: Studies have demonstrated an elevated risk of urological malignancies in individuals undergoing dialysis, which consequently leads to unfavorable prognoses and diminished quality of life for patients with end-stage kidney disease. Nevertheless, the absence of standardized recommendations for cancer screening and limited utilization of conventional screening methods within the dialysis population remain prevalent issues.

Methods: A meta-analysis was conducted on cohort studies published prior to June 2024, aiming to quantify the cancer risk among individuals undergoing dialysis. Random-effects meta-analyses were employed to combine standardized incidence rates (SIRs) along with their corresponding 95% confidence intervals, considering a p-value of less than 0.05 or an I² value exceeding 50%. Subgroup analyses, heterogeneity tests, and sensitivity analyses were performed as well.

Results: A total of 10 studies, consisting of 12 cohort studies, were ultimately identified, encompassing a collective patient population of 1,362,196 individuals. Compared to the general population, the pooled SIRs for all cancers except non-melanoma skin cancer (NMSC), major urological cancers (MUCs), cancers of the kidney/renal pelvis, bladder cancers and prostate cancers were 1.40 (95% CI: 1.28-1.54), 1.76 (95% CI: 1.45-2.14), 4.73 (95% CI: 3.96-5.64), 1.89 (95% CI: 1.61-2.21) and 0.94 (95% CI: 0.79-1.11), respectively. The cancer risk was notably elevated in specific subgroups of women, younger patients (age at first dialysis, 0-34 years), during the initial year of dialysis, and among Asian patients. SIRs differed when considering different primary renal diseases. However, high heterogeneity was observed among the studies investigating cancers during dialysis, while this heterogeneity did not have a substantial impact on the pooled SIRs for overall cancer, as determined through sensitivity analysis.

Conclusions: Compared with the general population, the dialysis population had a significantly increased risk of developing urological malignancies, particularly cancers of the kidney/renal pelvis. Our findings indicate a substantial increase in risks among female, young, Asian patients, during the first year of dialysis and highlight variations in SIRs based on primary renal disease. These results suggest the potential for adopting a more personalized approach to cancer screening in chronic dialysis patients. Given the considerable heterogeneity observed, further rigorous investigations are warranted to enhance our understanding in this area.