High incidence of hepatocellular carcinoma in ESRD patients: caused by high hepatitis rate or 'uremia'? a population-based study.
OBJECTIVE
A high incidence of hepatocellular carcinoma has been reported in end-stage renal disease patients. This study was undertaken to evaluate whether this was caused by a high rate hepatitis or 'uremia' per se.


METHODS
We used claims data of the Bureau of National Health Insurance of Taiwan for analysis. All patients diagnosed with end-stage renal disease having received their first dialysis between 1 January 2003 and 31 December 2007 (n = 38 714) were enrolled for the study. A database of 1 million randomly selected subjects matched for age, gender, hepatitis B and C infection, and liver cirrhosis for the same period was used as control (n = 38 714). The longest observation period was up to 31 December 2008.


RESULTS
There was no significant difference in the incidence of hepatocellular carcinoma between end-stage renal disease patients and their non-end-stage renal disease counterparts (2.03 per 1000 person-years vs. 2.10 per 1000 person-years, rate ratio = 0.947; 95% confidence interval: 0.792-1.132). End-stage renal disease patients with hepatocellular carcinoma had higher percentages of diabetes mellitus, hypertension, heart failure and gout (all P < 0.001), and they presented with a worse cumulative survival rate than the non-end-stage renal disease group (P < 0.001). End-stage renal disease patients developing hepatocellular carcinoma were younger, and had more comorbidities than their non-end-stage renal disease counterparts. End-stage renal disease (hazard ratio = 1.61) and diabetes mellitus (hazard ratio = 1.55) were found to be independent factors for mortality in hepatocellular carcinoma patients.


CONCLUSIONS
After matching for hepatitis and liver cirrhosis, end-stage renal disease is not associated with a higher incidence of hepatocellular carcinoma than the general population. The high incidence of hepatocellular carcinoma in end-stage renal disease patients was caused by a high viral hepatitis rate rather than 'uremia' per se. Owing to increased comorbidity, end-stage renal disease patients developing hepatocellular carcinoma had worse long-term survival than non-end-stage renal disease patients.
Division of Nephrology, Chi Mei Medical Center, Chia Nan University of Pharmacy and Science, Tainan City 71010, Taiwan. alfonjch@seed.net.tw
Jyh-Chang
JC
Hwang
Shih-Feng
SF
Weng
Rhay-Hung
RH
Weng
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000821:virology*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006525:Hepatitis, Viral, Human / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000150:complications*; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000821:virology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D017678:Sex Distribution; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D014511:Uremia / Q000150:complications*