Hepatocellular carcinoma in hemodialysis patients

// Chern-Horng Lee 1 , Sen-Yung Hsieh 2 , Chih-Chun Chang 3 , I-Kuan Wang 4 , Wen-Hung Huang 5,6 , Cheng-Hao Weng 5,6 , Ching-Wei Hsu 5,6 and Tzung-Hai Yen 5,6,7 1 Department of General Internal Medicine and Geriatrics, Chang Gung Memorial Hospital, Linkou, Taiwan 2 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan 3 Department of Clinical Pathology, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan 4 Department of Nephrology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan 5 Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan 6 Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan 7 Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan Correspondence to: Tzung-Hai Yen, email: // Keywords : hepatocellular carcinoma, end-stage renal disease, hemodialysis, liver cirrhosis, tumor stage Received : October 24, 2016 Accepted : April 01, 2017 Published : April 16, 2017 Abstract We investigated the rates and predictors of mortality in hepatocellular carcinoma (HCC) patients who were or were not undergoing long-term hemodialysis. The participants in this retrospective observational study were 1298 HCC patients (60.0 ± 12.1 years old, 72% male), of whom 172 were undergoing hemodialysis and 1126 were not. HCC patients on hemodialysis exhibited a higher hepatitis C virus carrier rate (49.4% versus 39.3%, P = 0.012), lower hepatitis B virus carrier rate (37.2% versus 58.3%, P < 0.001) and lower hepatitis B or C virus carrier rate (77.9% versus 89.3%, P < 0.001) than those not on hemodialysis. Serum alkaline phosphatase levels were higher in the hemodialysis than non-hemodialysis group (162.8 ± 141.1 u/l versus 124.6 ± 102.5 u/l, P < 0.001). By the end of the analysis, 32.0% of HCC patients on hemodialysis and 28.0% of those not on hemodialysis had died. Kaplan-Meier analysis confirmed that cumulative survival was poorer in HCC patients on hemodialysis ( P = 0.004). In a multivariate Cox regression model, hemodialysis ( P < 0.001), older age ( P < 0.001) and advanced tumor stages ( P < 0.001) were found to be risk factors for mortality. HCC patients on hemodialysis had a 2.036-fold greater chance of death than HCC patients not on hemodialysis. Prospective studies with longer follow-ups and larger samples are warranted.