Inzidenz und Spektrum maligner Erkrankungen bei Dialysepatienten in Nordbayern

 

 Buy Article Permissions and Reprints

Hintergrund und Fragestellung: Bei terminaler Niereninsuffizienz ist die Krebsinzidenz gesteigert, wobei bezüglich Häufigkeit und Verteilungsmuster der Tumoren große regionale Unterschiede bestehen. Nachdem in Deutschland dieser Thematik bislang nur wenig Beachtung geschenkt wurde, haben wir eine multizentrische Analyse (8 Dialysezentren) in Nordbayern zum Vorkommen maligner Erkrankungen durchgeführt.

Patienten und Methodik: Von insgesamt 2228 Patienten, die sich wegen terminaler Niereninsuffizienz in den Jahren 1990 - 99 einer Hämodialyse unterzogen hatten, wurden die Datensätze von 1727 Personen ausgewertet. Berücksichtigt wurden ausschließlich Kranke, bei denen ein Malignom im Verlaufe der Dialysetherapie aufgetreten war. Als alters- und geschlechtsentsprechende Vergleichspopulation diente das Krebsregister des Saarlandes, mit dessen Hilfe die erwartete Häufigkeit und Standard-Inzidenz-Ratio (SIR) der verschiedenen Karzinome für die Dialysepatienten berechnet wurden.

Ergebnisse: Insgesamt konnten 125 maligne Erkrankungen dokumentiert werden. Die Krebshäufigkeit war am höchsten im ersten Behandlungsjahr und lag in der Folgezeit deutlich niedriger. Von großer Bedeutung war ferner das Lebensalter der Patienten. So bestanden die höchsten Werte im mittleren Lebensalter (35 - 50 Jahre), während bei älteren Personen deutlich niedrigere Werte bestimmt wurden. Ein erhöhtes Risiko bestand für Malignome der Niere, Harnblase, Prostata, Leber, des Mundraums und Pharynx- und Larynxbereichs sowie des lymphatischen und blutbildenden Systems.

Folgerung: Die hohe Inzidenz von Krebserkrankungen bei terminaler Niereninsuffizienz verdient vermehrte Aufmerksamkeit. Vor allem in der Hochrisikogruppe der jüngeren Dialysepatienten erscheint ein regelmäßiges Screening insbesondere auf Tumoren der Niere und abführenden Harnwege sowie der Leber gerechtfertigt.

Background and objective: In end-stage renal failure the incidence of cancer is increased. With regard to frequency and pattern of distribution of the tumors, there are substantial regional differences. Since this topic has to date received only minimal attention in Germany, we undertook a multi-centric analysis (8 dialysis centres) in North Bavaria in order to address the occurrence of malignant diseases in end-stage renal failure.

Patients and methods: Of a total of 2228 patients, who underwent hemodialysis in the period from 1990 - 99 as a consequence of end-stage renal failure, the medical records of 1727 persons were analysed. Only those patients were considered, whose malignancy was diagnosed in the course of the dialysis. The Saarland cancer register served as a comparative age- and sex-matched population, with which we calculated the expected frequency of the various cancers as well as the standard incidence ratio (SIR) for the dialysis patients.

Results: In total 125 malignant diseases were documented. The cancer incidence was highest in the first year of treatment and was clearly lower in the subsequent periods. Of great importance was the age of the patients. The highest SIR scores were found for patients of middle age (35 - 50 years). An enhanced risk for cancer of the kidney, bladder, prostate, liver, oral cavity and the pharynx and larynx, as well as of the lymphatic and hemopoetic systems was found, while there was no or only a slight increase in the frequency of carcinoma of the mammary gland, stomach, colon-sigma-rectum and bronchial systems.

Conclusion: The high incidence of cancer in end-stage renal failure should be given greater attention. Particularly in the high-risk group of younger dialysis patients, a regular screening - especially for tumors of the kidney, bladder and liver - appears justified.

Literatur

• 1 Adami H O, Chow W H. et al . Excess risk of primary liver cancer in patients with diabetes mellitus.  J Natl Cancer Inst. 1996;  88 1472-1477
  Google Scholar
• 2 Bengtsson U, Anerwell L, Ekman L, Lehmann L. Transitional cell tumors of the renal pelvis in analgetic abusers.  Scan J Urol Nephrol. 1968;  2 145-150
  Google Scholar
• 3 Beutner K R. Human papillomavirus and human disease.  Am J Med. 1997;  102 9-15
  Google Scholar
• 4 Block G, Patterson B, Subar A. Fruit, vegetables and cancer prevention: A review of the epidemiologic evidence.  Nutr Cancer. 1992;  18 1-29
  Google Scholar
• 5 Brunner F P, Cellwood N N. Profile of patients on RRT in Europe and death rates due to major causes of death groups.  Kidney Int. 1992;  42 S4-S16
  Google Scholar
• 6 Buccianti G, Maisonneuve P, Ravasi B. et al . Cancer among patients on renal replacement therapy.  Int J Cancer. 1996;  66 591-593
  Google Scholar
• 7 Chudek J, Herbers J, Wilhelm M, Kenck C, Bugert P, Ritz E, Waldman F, Kovacs G. The genetics of renal tumors in end-stage renal failure differs from those occurring in the general population.  J Am Soc Nephrol. 1998;  9 1045-1051
  Google Scholar
• 8 Denton M D, Magee C C. et al . Prevalence of renal cell carcinoma in patients with ESRD pre-transplantation.  Kidney International. 2002;  61 2201-2209
  Google Scholar
• 9 Dunnill M S, Millard P R, Oliver P. Acquired cystic disease of the kidneys.  J Clin Pathol. 1977;  30 868-877
  Google Scholar
• 10 Fabrizi F. et al . Antibodies to hepatitis C virus (HCV) in chronic renal failure (CRF) patients on conservative therapy.  Nephrol Dial Transpl. 1994;  9 780-784
  Google Scholar
• 11 Fairley Z K, Sheil A R. et al . Das Risiko adrenogenitaler Malignome bei Dialysepatienten und Transplantierten.  Dialysejournal. 1994;  47 28-35
  Google Scholar
• 12 Heidland A, Bahner U, Vamvakas S. Incidence and spectrum of dialysis-associated cancer in three continents.  Am J Kidn Diseases. 2000;  35 347-353
  Google Scholar
• 13 Heidland A. et al . Advanced glycation end products and the progressive course of renal disease.  Am J Kidn Diseases. 2001;  38 (Suppl 1) S100-S106
  Google Scholar
• 14 Ishikawa I, Kovacs G. High incidence of papillary renal cell tumours in patients on chronic haemodialysis.  Histopathology. 1993;  22 135-139
  Google Scholar
• 15 Ishikawa I. Renal cell carcinoma in chronic hemodialysis patients - A 1990 questionnaire study in Japan.  Kidney Int. 1993;  41 S167-S169
  Google Scholar
• 16 Ishikawa I. Renal cell carcinoma in chronic hemodialysis patients - a questionnaire study in 2000.  J Jpn Soc Dialysis Therapy. 2002;  35 11-1118
  Google Scholar
• 17 Krebsregister Saarland Jahresbericht 1996 - 97. Saarland, Ministerium für Frauen, Arbeit, Gesundheit und Soziales 2000
  Google Scholar
• 18 Kopple J D, Massry S G. Is there an association between neoplasia and primary or secondary hyperparathyroidism?.  Am J Nephrol. 1988;  8 437-448
  Google Scholar
• 19 Levine E. Renal cell carcinoma in uremic acquired renal cystic disease: Indicence, detection and management.  Urol Radiol. 1992;  13 203-210
  Google Scholar
• 20 Lindner A, Farewell V T, Sherrard D J. High incidence of neoplasia in uremic patients receiving long-term dialysis.  Nephron. 1981;  27 202-206
  Google Scholar
• 21 Lornoy W, Becaus I, Morell V. A new complication in analgesic nephropathy: The development of renal cell carcinoma.  Kidney Int. 1986;  30 641-647
  Google Scholar
• 22 Maisonneuve P. et al . Cancer in patients on dialysis for end-stage renal disease: An international collaborative study.  Lancet. 1999;  354 93-99
  Google Scholar
• 23 Malachi T, Zevin D, Gafter U, Chagnac A, Slor H, Levi J. DNA repair and recovery of RNA synthesis in uremic patients.  Kidney Int. 1993;  44 385-389
  Google Scholar
• 24 Marple J T, MacDougall M. Development of malignancy in the end-stage renal disease patient.  Sem Nephrol. 1993;  13 306-316
  Google Scholar
• 25 Matas A J, Simmons R L, Kjellstrand C M, Buselmeier T J, Najarian J S. Increased incidence of malignancy during chronic renal failure.  Lancet. 1975;  I 883-886
  Google Scholar
• 26 Mellemgaard A, Moller H, Ohlsen J, Jensen O N. Diuretics may increase the risk of renal cell carcinoma.  Cancer Causes Control. 1992;  3 309-312
  Google Scholar
• 27 Orth S R. et al . The renal risks of smoking.  Kidney Int. 1997;  51 1669-1677
  Google Scholar
• 28 Pasche B. Role of transforming growth factor ß in cancer.  J Cell Physiol. 2001;  186 153-168
  Google Scholar
• 29 Pecqueux J C. et al . Cancer incidence in patients on chronic dialysis and in renal transplant recipients.  Urol Int. 1990;  45 290-292
  Google Scholar
• 30 Penn I, Starzl R. Malignant tumors arising de novo in immunosuppressed organ transplant recipients.  Transplantation. 1972;  14 407-417
  Google Scholar
• 31 Penn I. Tumors after renal and cardiac transplantation.  Hematol Oncol Clin North Am. 1993;  7 431-445
  Google Scholar
• 32 Perry R J, Griffiths W, Dextraze P, Solomon R J, Trebbin W M. Elevated nicotine levels in patients undergoing hemodialysis.  Am J Med. 1984;  76 241-246
  Google Scholar
• 33 Port F K, Ragheb N E, Schwartz A G, Hawthorne V M. Neoplasms in dialysis patients: a population-based study.  Am J Kidney Dis. 1989;  14 119-123
  Google Scholar
• 34 Ragheb N E, Port F K, Schwartz A G. The risk of cancer of patients in dialysis: A review.  Sem Dial. 1991;  4 253-257
  Google Scholar
• 35 Roselaar S E. et al . Detection of uremic plasma by electron spin in resonance spectroscopy.  Kidney Int. 1995;  48 199-206
  Google Scholar
• 36 Slifkin R F, Goldberg J, Neff M S, Baez A, Mattoo N, Gupta S. Malignancy in end-stage renal disease.  Trans Am Soc Artif Organs. 1977;  23 34-39
  Google Scholar
• 37 Spiegel D. et al . Incidence of renal cell carcinoma in natural history of acquired renal cystic disease in end-stage renal disease.  Am J Nephrol. 1991;  11 166-167
  Google Scholar
• 38 Stopper H. et al . Increased genomic damage in lymphocytes of patients before and after long-term hemodialysis therapy.  Am J Kid Diseases. 1999;  34 433-437
  Google Scholar
• 39 Stopper H, Boullay F. et al . Comet-assay analysis identifies genomic damage in lymphocytes of uremic patients.  Am J Kidn Dis. 2001;  38 296-301
  Google Scholar
• 40 Stopper H, Schinzel R, Sebekova K, Heidland A. AGE-induced genomic damage in the tubule cell line LLC-PK1.  J Am Soc Nephrol. 2001;  12 622A
  Google Scholar
• 41 Vamvakas S, Bahner U, Becker P. et al . Impairment of DNA repair in the course of long-term hemodialysis and under cyclosporine immune suppression after renal transplantation.  Transpl Proc. 1996;  28 3468-3473
  Google Scholar
• 42 Vamvakas S, Bahner U, Heidland A. Cancer in end-stage renal disease: Potential factors involved.  Am J Nephrol. 1998;  18 89-95
  Google Scholar
• 43 Winkelspecht B. et al . Serological evidence for reactivation of EBV infection due to uremic immunodeficiency.  Nephrol Dial Transplant. 1997;  12 2099-2104
  Google Scholar
• 44 Yamamoto T. et al . Epstein-Barr virus activity in patients on chronic hemodialysis.  Nephron. 1995;  70 449-454
  Google Scholar

Priv.-Doz. Dr. Markus Teschner

Kuratorium für Dialyse und Nierentransplantation

Hans-Brandmann-Weg 1

97080 Würzburg

Phone: 0931/260-3672

Fax: 0931/260-3673

Email: kfh-wuerzburg@t-online.de