| Objective:It has been reported that End-stage renal disease(ESRD)patients receiving dialysis tend to have an increased risk of cancer.However,studies on the degree of this risk have remained inconclusive.The present meta-analysis was therefore performed to quantify the cancer risk in ESRD patients.So as to provide evidence-based medical data for the prevention and treatment of cancer,which can reduce risk of cancer for ESRD patients and prolong the survival time.Materials and methods:Studies assessing cancer risk in ESRD patients published before December2020 were included following systematic searches with of PubMed,EMBASE,Cochrane Library and the reference lists of the studies retrieved.We use Rev Man5.3for statistical analysis after collecting data and extracting information according to the criteria of meta-analysis.Results:A total of 21 studies including 22 cohort studies and 1 case-control study were eventually identified,which comprised a total of 1,673,858 ESRD patients.According to the Newcastle-Ottawa Scale(NOS),all studies were of high quality.We used the meta-analysis to evaluate the risk of cancer in ESRD patients,the results were as follows:In comparison with the general population,the risk of cancer(including non-melanoma skin cancer)for ESRD patients was increased.The standardized incidence ratio(SIR)and 95% confidence interval(CI)of ESRD patients was1.42(1.27,1.58).Meanwhile,the risk of cancer(excluding non-melanoma skin cancer)for ESRD patients was also increased(SIR=1.35,95%CI [1.24,1.48]),and the P values were less than 0.05,which was statistically significant.High risks were observed for cancer of the kidney(SIR=4.76,95%CI [4.04,5.60]),thyroid(SIR=3.75,95%CI [1.87,7.52]),myeloma(SIR=3.16,95%CI [2.54,3.94])and bladder(SIR=2.79,95%CI [2.07,3.74]).The SIR and 95%CI in female and male patients were 1.49(1.30,1.70)and 1.31(1.19,1.45)respectively.The risk for cancer was highest in the first year after receiving dialysis therapy(SIR=2.12,95%CI [1.56,2.89]).The SIRs and 95%CIs in ESRD patients whose dialysis duration was 1-2 years,3-5 years and >5 years were 1.40(1.20,1.64),1.22(1.04,1.44)and 0.98(0.40,2.40)respectively.Young patients who started dialysis before 34 years old had a higher risk of cancer development(SIR=4.78,95% CI[ 3.10,7.39])than the other two groups.The SIRs and 95%Cis in ESRD patients who started dialysis at age 35-64 years old and beyond 65 years old were 1.88(1.41,2.50)and 1.13(0.95,1.34).We also analyzed the risk of cancer in different causes of ESRD.A trend of an increased SIR of cancer was observed in toxic nephropathies(SIR=2.03,95%CI [1.54,2.69],obstructive nephropathies(SIR=1.55,95%CI[1.16,2.09])and glomerulonephritis(SIR=1.53,95%CI [1.34,1.75]).Patients with chronic liver disease had a 66% higher risk for new cancer(HR=1.66,95%CI[1.46,1.89].The P values above were less than 0.05,which was statistically significant.While,there is no different risk of cancer development between ESRD patients who received different mode of dialysis(HR=0.86,95%CI [0.71,1.03]).Conclusion:1.Compared with the general population,ESRD patients have a significantly increased risk of overall cancer and the majority of specific cancer types,such as renal cell carcinoma,thyroid carcinoma,myeloma and bladder cancer.Cancer risk was found to be significantly higher at first year after dialysis,at age less than 34 years old,at toxic nephropathies as cause of ESRD and at patients who complicated chronic liver disease.Therefore,more attention should be paid to individualized regular cancer screenings in ESRD patients.2.The mode of dialysis has nothing to do with the excess risk of cancer in ESRD patients. |
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