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Cancer Risk Among Children Undergoing Renal Replacement Therapy

Results From the Israel National Renal Replacement Therapy Registry, 1990-2012

Nuss, Naama, MD, MPH*,†; Libruder, Carmit, MSc*; Dichtiar, Rita, MPH*; Weinstein, Talia, MD‡,§; Keinan-Boker, Lital, MD*,∥; Shohat, Tamy, MD*,§,¶; Golan, Eliezer, MD§,#,**

Journal of Pediatric Hematology/Oncology: November 2018 - Volume 40 - Issue 8 - p e525–e530
doi: 10.1097/MPH.0000000000001202
Online Articles: Original Articles

Background: Patients with end-stage renal disease who undergo chronic renal replacement therapy (RRT) have a higher incidence of cancer. A limited number of studies addressed the risk for cancer in children exposed to RRT. The purpose of the present study was to examine whether children undergoing RRT in Israel are at increased risk for all-site and specific cancers.

Subjects and Methods: The study population comprised 674 children 0 to 19 years of age who were registered between January 1990 and December 2012 in the Israel National Renal Replacement Therapy Registry. The Registry database was linked with the Israel National Cancer Registry to trace cancer incidence. Variables associated with malignancy were estimated by univariate analysis. Standardized incidence ratios for cancer were calculated using the general Israel population 0 to 15 years of age, for the corresponding years 1990-2012, as a reference.

Results: Seventeen children developed cancer during the follow-up period. Younger age at RRT initiation was the only variable associated with malignancy in the univariate analysis (hazard ratio, 0.91; 95% confidence interval, 0.84-0.99; P=0.03). Cancer incidence was 6.7-fold higher among children undergoing RRT than the general population.

Conclusions: Children treated by chronic RRT have a higher incidence of cancer than their peers, and therefore should be followed closely.

*Israel Center for Disease Control, Israel Ministry of Health

**Israel Renal Registry, Ramat-Gan

Public Health Department, Israel Ministry of Health

Department of Nephrology, Tel Aviv Medical Center

School of Public Health

§Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv

School of Public Health, University of Haifa, Haifa

#Department of Nephrology and Hypertension, Meir Medical Center, Kfar-Saba, Israel

The authors declare no conflict of interest.

Reprints: Naama Nuss, MD, MPH, 12 Ha’arba’a Street, Tel-Aviv 6473912, Israel (e-mails:;

Received December 10, 2017

Accepted March 14, 2018

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