SP705CANCER AND END-STAGE KIDNEY DISEASE: DEATH SENTENCE?

Abstract

Introduction and Aims: End-stage kidney disease (ESKD) is associated with a known burden in morbidity and mortality, an aspect also observed with malignant diseases. Hence, patients ( pts) with cancer and ESKD have the cumulative effect of 2 severe diseases, thereby frequently raising the question of whether dialysis (as opposed to comfort measures) should be implemented. Thoughtful decision-making requires acquaintance with the behavior and evolution of this particular population. The primary goal of this study was to characterize a group of oncologic pts on chronic hemodialysis program.We also describe a group on non-oncologic pts undergoing dialysis in the same center. Methods: Retrospective analysis of oncologic and non-oncologic pts on chronic dialysis between January 1991 and September 2014. Results: 195 pts were treated during this period, 140 of whom with locally advanced or metastatic malignancies. Whitin the oncologic group, 52.9% were female; mean age at the beginning of renal replacement therapy was 69 (IQR=58-76) years and the median follow-up time was 23.4 (IQR: 9.1-49.6) months. 47.7% had hypertension and 25.2% had type 2 diabetes. The main etiologies for kidney disease were: multiple myeloma (MM) (25%), chronic interstitial disease/obstruction (24.3%) and loss of renal mass/ surgery (17.1%). The remaining 33.6% had no apparent relation to cancer. The most common tumors were genitourinary (40.5%), MM (23.4%) and gastrointestinal (10.8%). 21% had multiple tumors. 16.2% had radiation enteritis, 88.9% of whom related to genitourinary cancers. Survival was 58.5% at 2 years and 33.5% at 5 years. The estimated median survival time was 35 months. Cox regression showed that tumor type was a prognostic factor for overall survival. MM (HR=7.974; 95% CI: 3.784-16.805) and gastrointestinal (HR=2.943; 95% CI: 1.216-7.121) tumors were associated with increased hazard ratio of death and shorter survival time. 67.1% pts died, 7.9% were transferred to other centers, 4.3% recovered renal function, 1 (0.7%) underwent kidney transplant (KT) and 20.0% were still alive at the time of this report. Of those who recovered renal function, all had MM and mean time on dialysis was 4.5 months. Pts with non-oncologic disease were younger (mean age 62 years; IQR=45-74; p<0.05) and their most common etiology for ESKD was glomerulonephritis (40%) and diabetic nephropathy. Survival was significantly higher than in the oncologic group (87.7% at 2 years and 69,8% at 5 years; p<0.001). 29.1% of pts underwent KT, 29.1% were transferred to other centers, 23.6% died and 18.2% were still alive at the time of this report. None had renal function recovery. Conclusions: The most common malignancy among pts with advanced oncological disease on dialysis was MM. MM pts had the worst prognosis, but, concurrently, were the only ones with potential renal function recovery. Overall survival was unexpectedly high at 2 years and, notably, 1/3 was still alive after 5 years. Accordingly, decisionmaking in patients with cancer and ESKD must be individualized, integrating clinical assessment, accurate prognostication and treatment options in each particular case.