Cancer and End-Stage Kidney Disease: A Death Sentence?

• Autor(a) principal: Chuva,Teresa
• Data de Publicação: 2016
• Outros Autores: Maximino,José, Barbosa,Joselina, Henrique,Rui, Silva,Sandra, Santos,Paulo, Loureiro,Alfredo
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692016000400006
• topic: cancer; end-stage kidney disease; haemodialysis; prognosis; survival

Background: End-stage kidney disease is associated with considerable morbidity and mortality, a feature that is shared with malignant neoplasms. Hence, patients with the cumulative effect of these two diseases frequently give rise to the question of whether dialysis should be implemented. The primary goal of this study was to characterize the clinical progression and evaluate the outcome of a group of oncology patients on chronic haemodialysis and also to identify the characteristics associated with prolonged survival. Methods: Retrospective analysis of all patients on the chronic haemodialysis programme in an oncology hospital-based haemodialysis centre between January 1991 and September 2014. Results: 141 patients were treated during this period. The main aetiologies for end-stage kidney disease were multiple myeloma (24.8%) and chronic interstitial disease (22.7%), while the most common tumours were genitourinary cancer (47.5%) and multiple myeloma (24.8%). Multiple tumours were present in 22.0% of patients and 19.2% harboured metastatic disease. Overall, 66.7% of patients died during this period; 7.8% were transferred to other centres as a result of clinical stability; 4.3% recovered renal function; 1.4% received a kidney transplant and 19.9% were still alive at the end of the study. Overall survival was 58.8% at 2 years and 34.8% at 5 years. Multiple myeloma (HR=5.950; 95% CI: 2.512-14.092) and gastrointestinal cancers (HR=3.277; 95% CI: 1.176-9.134) were associated with increased likelihood of death. Conclusions: Survival among patients with often locally advanced or metastatic oncological disease on chronic haemodialysis was unexpectedly high, with 1/3 still alive at 5 years. Accordingly, decision-making in the cancer