Case-control study of erythropoiesis-stimulating agents and development of cancer among patients receiving dialysis

Although erythropoiesis-stimulating agents (ESAs) are widely used to treat anemia in patients with kidney failure, concerns have been raised about their potential to promore tumor growth. A case-control study in South Korea examined the association between high-dose ESA use and cancer development among patients receiving long-term dialysis. The study identified patients in the Korean National Health Insurance Service database with kidney failure who began long-term dialysis treatment and received ESAs between 2006 and 2017. Each case with incident cancer was matched with 4 controls based on age, sex, follow-up time, year of dialysis initiation, and dialysis modality. ESA exposure was categorized as high or low dose according to the median of the mean weekly dose of each ESA drug. A total of 9776 patients (mean age 62.2 ± 12.2 years; 64.4% male) undergoing dialysis were included; 2320 patients with incident cancer were matched to 7456 controls. After multivariable adjustment, high-dose ESA use was associated with increased odds of cancer development (aOR 1.23; 95% CI 1.11-1.35) compared with low-dose use. Stratified by age, the odds of cancer development were 0.90 (95% CI 0.77-1.05) among patients aged younger than 60 years and 1.47 (1.30-1.67) among patients aged 60 years or older. The authors conclude that high-dose ESA use was associated with greater odds of new cancer development among patients undergoing dialysis; caution should be exercised to avoid excessively high hemoglobin levels during ESA therapy.