title: Mortality and hemorrhagic complications associated with radiofrequency ablation for treatment of hepatocellular carcinoma in patients on hemodialysis for end-stage renal disease: A nationwide survey.
abstract: OBJECTIVE
  Because of the rarity of invasive treatment for hepatocellular carcinoma (HCC) in patients on hemodialysis (HD) for end-stage renal disease (ESRD), the risks associated with radiofrequency ablation (RFA) in such patients remain uncertain. We used a nationwide database to investigate in-hospital mortality and hemorrhagic complications following RFA in patients on HD for ESRD.
  
  
  METHODS
  Using the Japanese Diagnosis Procedure Combination database, we enrolled patients on HD for ESRD who underwent RFA for HCC. For each patient, we randomly selected up to four non-dialyzed patients using a matched-pair sampling method based on patient age, sex, treatment hospital, and treatment year. In-hospital mortality and hemorrhagic complications were compared between dialyzed and non-dialyzed patients following RFA.
  
  
  RESULTS
  We compared matched-pair samples of 437 dialyzed and 1345 non-dialyzed patients. In patients on HD for ESRD, mortality was significantly lower in those aged ≤70 years than in older patients (P = 0.02). In-hospital mortality was significantly higher in dialyzed ESRD patients than in non-dialyzed patients (1.1% vs 0.15%, respectively; odds ratio = 7.77, P < 0.001). Hemorrhagic complications differed significantly between dialyzed ESRD patients and non-dialyzed patients (3.4% vs 0.87%, respectively; odds ratio = 4.75, P < 0.001).
  
  
  CONCLUSIONS
  In-hospital mortality following RFA was higher in dialyzed ESRD patients than in non-dialyzed patients. The indications for RFA in dialysis-dependent patients should be considered carefully. Patient age may be a useful indicator when considering RFA for HCC in patients on HD for ESRD.
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Sato
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Tateishi
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsui
authors.affiliation: Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.affiliation: Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality; D008107:Liver Diseases / Q000150:complications* / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D006435:Renal Dialysis / Q000401:mortality
keywords: Diagnosis Procedure Combination database; dialysis; end-stage renal disease; liver tumor