Kang Seok Hui, Lim Yu Jeong, Kim Bo Yeon, Choi Ji Young, Do Jun Young
Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea.
Health Insurance Review and Assessment Service, Wonju, Republic of Korea.
Clin Kidney J. 2025 Jun 16;18(6):sfaf148. doi: 10.1093/ckj/sfaf148. eCollection 2025 Jun.
Since erythropoiesis-stimulating agent (ESA) types vary in their affinity for receptors, investigating their association with malignancies could offer valuable insights. This study aims to evaluate the effect of ESA types on malignancy incidence in hemodialysis (HD) patients.
The Health Insurance Review and Assessment Service has operated a nationwide HD quality assessment program to address the high medical costs and mortality rates among HD patients. This retrospective study analyzed data from 33 960 HD patients, who underwent fourth and fifth HD quality assessments. Participants were divided into three groups: short-, intermediate- and long-acting groups. The onset of any malignancy was defined as the date of the first diagnosis based on International Classification of Diseases, Tenth Revision codes for the 12 most common malignancies. Patient survival was assessed for those with a first diagnosis of any malignancy during follow-up.
The short-, intermediate- and long-acting groups comprised 26 006, 6448 and 1506 patients, respectively (over ∼75 months of follow-up). The 5-year malignancy-free rates were 88.4%, 88.2% and 87.0% for short-, intermediate- and long-acting groups, respectively ( = .024 for short/intermediate-acting vs long-acting group). Univariable and multivariable analyses showed higher malignancy risk in the long-acting group, especially in males, older individuals and those on higher ESA doses. We performed analyses using a balanced cohort after propensity score weighting. The balanced cohort also confirmed higher malignancy risk in the long-acting group, while survival rates remained unaffected by ESA type.
Our population-based cohort study reveals an association between long-acting ESAs use and the incidence of any malignancy, with a particularly strong influence on high-dose users. This suggests that avoiding long-acting ESAs may be advisable for patients at high risk of malignancy.
由于促红细胞生成素（ESA）类型对受体的亲和力不同，研究它们与恶性肿瘤的关联可能会提供有价值的见解。本研究旨在评估ESA类型对血液透析（HD）患者恶性肿瘤发生率的影响。
健康保险审查与评估服务机构开展了一项全国性的HD质量评估项目，以应对HD患者的高医疗成本和高死亡率。这项回顾性研究分析了33960名接受第四次和第五次HD质量评估的HD患者的数据。参与者被分为三组：短效、中效和长效组。任何恶性肿瘤的发病定义为基于国际疾病分类第十版编码的12种最常见恶性肿瘤的首次诊断日期。对随访期间首次诊断为任何恶性肿瘤的患者进行生存评估。
短效、中效和长效组分别包括26006例、6448例和1506例患者（随访时间超过约75个月）。短效、中效和长效组的5年无恶性肿瘤生存率分别为88.4%、88.2%和87.0%（短效/中效组与长效组相比，P = 0.024）。单变量和多变量分析显示长效组的恶性肿瘤风险更高，尤其是男性、老年人和使用高剂量ESA的患者。我们在倾向得分加权后使用平衡队列进行分析。平衡队列也证实了长效组的恶性肿瘤风险更高，而生存率不受ESA类型的影响。
我们基于人群的队列研究揭示了长效ESA的使用与任何恶性肿瘤的发生率之间的关联，对高剂量使用者的影响尤为强烈。这表明对于恶性肿瘤高危患者，避免使用长效ESA可能是明智的。
