Abstract
In end-stage renal disease (ESRD) patients receiving dialysis, anemia is common and related to a higher mortality rate. Erythropoietin (EPO) resistance and iron refractory anemia require red blood cell transfusions. Myelodysplastic syndrome (MDS) is a disease with hematopoietic dysplasia. There are limited reports regarding ESRD patients with MDS. We aim to assess whether, for ESRD patients, undergoing dialysis is a predictive factor of MDS by analyzing data from the Taiwan National Health Insurance Research Database. We enrolled 74,712 patients with chronic renal failure (ESRD) who underwent dialysis and matched 74,712 control patients. In our study, we noticed that compared with the non-ESRD controls, in ESRD patients, undergoing dialysis (subdistribution hazard ratio [sHR] = 1.60, 1.16–2.19) and age (sHR = 1.03, 1.02–1.04) had positive predictive value for MDS occurrence. Moreover, more units of red blood cell transfusion (higher than 4 units per month) was also associated with a higher incidence of MDS. The MDS cumulative incidence increased with the duration of dialysis in ESRD patients. These effects may be related to exposure to certain cytokines, including interleukin-1, tumor necrosis factor-α, and tumor growth factor-β. In conclusion, we report the novel finding that ESRD patients undergoing dialysis have an increased risk of MDS.
Highlights
In end-stage renal disease (ESRD) patients receiving dialysis, anemia is common and related to a higher mortality rate
Hamza et al reported 20 hemodialysis (HD) patients with Myelodysplastic syndrome (MDS), including 10 chronic kidney disease (CKD) patients diagnosed with MDS before HD and 10 patients diagnosed with MDS 2 years after HD
CKD patients diagnosed with MDS before HD showed lower revised international prognostic scoring system (IPSS-R) scores and better survival than those diagnosed with MDS after HD15
Summary
In end-stage renal disease (ESRD) patients receiving dialysis, anemia is common and related to a higher mortality rate. Erythropoietin (EPO) resistance and iron refractory anemia require red blood cell transfusions. The MDS cumulative incidence increased with the duration of dialysis in ESRD patients These effects may be related to exposure to certain cytokines, including interleukin-1, tumor necrosis factor-α, and tumor growth factor-β. Anemia is a common feature in late-stage chronic kidney disease (CKD), especially in patients receiving dialysis. The major mechanisms that contribute to anemia in CKD are shortened red cell survival[2], decreased erythropoietin (EPO) production[3], and retained inhibitors or toxic metabolites in end-stage renal disease (ESRD) that inhibit e rythropoiesis[4,5,6]. In the present large-scale study in the Taiwanese population, we investigated whether receiving dialysis increases the risk of MDS for ESRD patients
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