Dialysis-requiring acute kidney injury increases risk of long-term malignancy: a population-based study

Background A cute kidney injury (AKI) is gaining world-wide attention recently, emerging as a major public health threat. However, the association between the development of AKI and subsequent malignancy has not been studied before. Methods We conducted a population study based on the Taiwan National Health Insurance database, using 1,000,000 representative database during 2000-2008. All patients' survival to discharge from index hospitalization with recovery from dialysis-requiring AKI were identified (recovery group), and matched with those without recovery and those without AKI, at a 1: 1: 1 ratio. Results We identified 625 individuals more than 18 years old [352 male (56.5 %); mean age, 63.3 years] in recovery group and matched 625 individuals in each group. During a mean followed-up of 3.7 years, the incidences of new-onset malignancy were 4.2, 2.9, and 2.6 per 100 person-year among the non-recovery, the recovery, and the non-AKI group, respectively. After adjustment, the recovery group was more likely to develop long-term de novo malignancy than those without AKI [hazard ratio (HR) 1.44, 95 % confidence interval (CI) 1.02-2.03; p = 0.04], while less likely than those who did not recover (HR 0.66, 95 % CI 0.45-0.98; p = 0.04). Conclusions Dialysis-requiring AKI can post a long-term risk of de novo malignancy for those who survive from the initial insult. Even patients who have recovered from dialysis still carry a significantly higher possibility of developing malignancy than those without AKI episode.