Clinical Research Papers:
Hepatocellular carcinoma in hemodialysis patients
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Chern-Horng Lee1, Sen-Yung Hsieh2, Chih-Chun Chang3, I-Kuan Wang4, Wen-Hung Huang5,6, Cheng-Hao Weng5,6, Ching-Wei Hsu5,6 and Tzung-Hai Yen5,6,7
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
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
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.
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