title: Higher risk of urothelial carcinoma in the upper urinary tract than in the urinary bladder in hemodialysis patients.
abstract: Purpose This study used the a nationwide population-based retrospective cohort study with the claims data from the Taiwan National Health Insurance Research Database to investigate the risk of urothelial carcinoma (UC) for hemodialysis (HD) patients. Methods The study population consisted of 2689 patients with end-stage renal disease (ESRD) newly diagnosed in 2000-2002 and underwent maintenance HD. Then, 21,449 reference patients were collected without HD randomly selected and matched with sex and age. The exclusion criteria were previous long-term analgesics and Chinese medication usage. Incidence density rates of UC in upper urinary tract (UTUC) and bladder (UBUC) were estimated for both cohorts by the end of 2012. Hazard ratios (HRs) of UC were measured in association with HD, covariates, and comorbidity. Results The incidence of UC was significantly higher in the HD cohort than in the reference cohort for both UT (21.8 vs. 0.65 per 10,000 person-years) and UB (17.7 vs. 3.55 per 10,000 person-years). The multivariate Cox proportional hazard regression analysis showed that the HRs of UTUC in HD cohort was 33.3 (95% CI = 15.9-69.5) and 5.14 for UBUC (95% CI = 3.24-8.15). The risk increased further for HD patients with comorbidity of hematuria, urinary tract infection (UTI) or hydronephrosis. Conclusion Patients with ESRD on HD are at a high risk of developing UC, especially UTUC in Taiwan. They will be paid more frequent to check urine analysis, urine cytology, and upper urinary tract survey.
authors.affiliation: a Department of Urology , China Medical University Hospital , Taichung , Taiwan ;
authors.forename: Po-Jen
authors.initials: PJ
authors.lastname: Hsiao
authors.affiliation: a Department of Urology , China Medical University Hospital , Taichung , Taiwan ;
authors.forename: Po-Fan
authors.initials: PF
authors.lastname: Hsieh
authors.affiliation: a Department of Urology , China Medical University Hospital , Taichung , Taiwan ;
authors.forename: Chao-Hsiang
authors.initials: CH
authors.lastname: Chang
authors.affiliation: a Department of Urology , China Medical University Hospital , Taichung , Taiwan ;|b Department of Urology , Tainan Municipal an-Nan Hospital-China Medical University , Tainan , Taiwan ;
authors.forename: Hsi-Chin
authors.initials: HC
authors.lastname: Wu
authors.affiliation: a Department of Urology , China Medical University Hospital , Taichung , Taiwan ;
authors.forename: Chi-Rei
authors.initials: CR
authors.lastname: Yang
authors.affiliation: a Department of Urology , China Medical University Hospital , Taichung , Taiwan ;|c Graduate Institute of Clinical Medical Science , China Medical University , Taichung , Taiwan.
authors.forename: Chi-Ping
authors.initials: CP
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D001743:Urinary Bladder / Q000473:pathology; D014571:Urologic Neoplasms / Q000453:epidemiology / Q000473:pathology
keywords: End-stage renal disease; hemodialysis; upper urinary tract; urinary bladder; urothelial carcinoma,