Comparison of trends in colorectal cancer screening in the US end-stage renal disease population and the US Medicare population.
BACKGROUND
Although patients treated with maintenance hemodialysis are at an increased risk of colorectal cancer compared with the general population, national practices for colorectal cancer screening have not been reported in this population. We assessed the performance of colorectal cancer screening in the US end-stage renal disease program in comparison with the US Medicare population.


METHODS
We studied the United States Renal Data System for US prevalent hemodialysis patients between 2002 and 2011 who had Medicare as their primary insurer. We assessed procedure codes for performance of common colorectal cancer screening tests, including fecal occult blood testing, sigmoidoscopy and colonoscopy. We assessed screening sigmoidoscopy and screening colonoscopy only and excluded patients who had preexisting colon cancer or gastrointestinal hemorrhage. Because colorectal cancer screening recommendations are established for hemodialysis patients who have been listed for kidney transplantation, but no general recommendations exist for patients who are not wait-listed, we assessed colorectal cancer screening separately for the two groups.


RESULTS
We found that 1-year performance of colonoscopy in wait-listed hemodialysis patients was similar to or higher than that in general Medicare patients of the same age, while performance of colonoscopy in non-wait-listed patients was significantly lower than among general Medicare patients of the same age.


CONCLUSIONS
Given improved survival among hemodialysis patients in the last decade, the utility of colorectal cancer screening even among non-wait-listed hemodialysis patients should be reassessed.
Social & Scientific Systems, Inc. , Silver Spring, MD , USA.
Chyng-Wen
CW
Fwu
Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases , National Institutes of Health , 6707 Democracy Boulevard, Bethesda, MD 20892-5458 , USA.
Paul L
PL
Kimmel
Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases , National Institutes of Health , 6707 Democracy Boulevard, Bethesda, MD 20892-5458 , USA.
Paul W
PW
Eggers
Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases , National Institutes of Health , 6707 Democracy Boulevard, Bethesda, MD 20892-5458 , USA.
Kevin C
KC
Abbott
USRDS; colorectal cancer; dialysis; kidney; screening; transplant
Medicine (Baltimore). 2015 Sep;94(36):e1482
26356710
Am J Kidney Dis. 2000 Feb;35(2):237-43
10676722
Nephrol Dial Transplant. 2013 Apr;28(4):917-26
23182812
Artif Organs. 1990 Apr;14(2):95-7
2350261
CA Cancer J Clin. 2008 May-Jun;58(3):161-79
18443206
Nat Rev Gastroenterol Hepatol. 2010 Oct;7(10):557-64
20736921
Can J Kidney Health Dis. 2014 Sep 02;1:21
25780611
Clin J Am Soc Nephrol. 2007 Sep;2(5):1008-13
17702737
CMAJ. 2005 Nov 8;173(10):1181-4
16275969
Transplantation. 2001 May 15;71(9):1189-204
11397947
Semin Dial. 2011 Jul-Aug;24(4):364-5
21801210
Am J Transplant. 2001;1 Suppl 2:3-95
12108435
Med Care. 2014 Apr;52(4):e21-9
22437619
Ann Surg Oncol. 2013 Nov;20(12):3885-91
23807660
Am J Kidney Dis. 2007 Nov;50(5):890-8
17954303
J Am Soc Nephrol. 2007 Dec;18(12):3199-205
17978309
PLoS One. 2015 Apr 13;10(4):e0122856
25874862
Nephrol Dial Transplant. 2009 Jul;24(7):2136-43
19188339
J Am Soc Nephrol. 2007 Dec;18(12):3192-8
17978311
Gastroenterology. 2013 Oct;145(4):895-7; discussion 897
23973676
JAMA Intern Med. 2013 Apr 8;173(7):551-6
23478904
Arch Intern Med. 2008 Mar 24;168(6):593-7
18362251
Am J Kidney Dis. 2015 May;65(5):763-72
25662835
J Am Soc Nephrol. 1995 Jul;6(1):1-34
7579061
Arch Intern Med. 1996 Jun 24;156(12):1345-50
8651845
Nephrol Dial Transplant. 2015 Nov;30(11):1790-7
25007790
Ann Intern Med. 2015 May 19;162(10):718-25
25984847