Abstract
The association between urothelial carcinoma (UC) and subsequent ESRD incidence has not been confirmed. This was a population-based study using claims data from the Taiwan National Health Institutes from 1998 to 2010. The study cohort consisted of 26,017 patients with newly diagnosed UC and no history of ESRD, and the comparison cohort consisted of 208,136 matched enrollees without UC. The incidence of ESRD was ascertained through cross-referencing with a registry for catastrophic illnesses. Cox proportional hazard regression analysis was used to estimate the risk of ESRD associated with UC and UC subtype. A total of 979 patients (3.76%) from the UC group and 1,829 (0.88%) from the comparison group developed ESRD. Multivariable analysis indicated that compared with the comparison group, the hazard ratios (HRs) for ESRD were 7.75 (95% confidence interval [CI]: 6.84 to 8.78) and 3.12 (95% CI: 6.84 to 8.78) in the cohort with upper urinary tract UC (UT-UC) and bladder UC (B-UC), respectively. In addition, there were significantly increased risks for ESRD in UC patients receiving and not receiving nephrouretectomies or aristolochic acids (AA). Moreover, the UC patients receiving segmental ureterectomy and ureteral reimplantation had approximately 1.3-fold and 2.4-fold increased risk for ESRD after control for confounders, respectively. Thus, our data indicate that UT-UC and B-UC independently increased the risk for ESRD in patients after considering about nephrouretectomies or aristolochic acids (AA). In addition, UC patients receiving segmental ureterectomy and ureteral reimplantation had increased risk for ESRD.
Highlights
End-stage renal disease (ESRD) is a significant public health issue in Taiwan and internationally because patients require significant healthcare services and suffer from reduced quality of life
Multivariable analysis indicated that compared with the comparison group, the hazard ratios (HRs) for ESRD were 7.75 (95% confidence interval [CI]: 6.84 to 8.78) and 3.12 in the cohort with upper urinary tract urothelial carcinoma (UC) (UT-UC) and bladder UC (B-UC), respectively
Our data indicate that UT-UC and B-UC independently increased the risk for ESRD in patients after considering about nephrouretectomies or aristolochic acids (AA)
Summary
End-stage renal disease (ESRD) is a significant public health issue in Taiwan and internationally because patients require significant healthcare services and suffer from reduced quality of life. In Taiwan, urothelial carcinoma (UC) is common among patients with CKD and ESRD [4]. Some research suggests that patients with CKD or ESRD have a greater risk for cancer [5, 6]. Different dialysis modalities and gender may modify the risk for cancer in patients with ESRD [8]. UC itself may promote the development of ESRD, especially in patients with upper urinary tract-UC (UT-UC) [9]. Limited research has evaluated the correlation between the location (or subtype) of UC and the incidence of subsequent ESRD. We propose that patients with UC may face greater risk of ESRD and that different UC subtypes are associated with different risks.
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