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J Formos Med Assoc. 2015 Jan;114(1):52-7. doi: 10.1016/j.jfma.2013.10.022. Epub 2013 Dec 18.

Increased risk of urothelial cancer in young and middle aged patients with end-stage renal disease.

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Department of Urology, National Taiwan University Hospital, Taipei, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan.
Department of Statistics, Feng Chia University, Taichung, Taiwan.
Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan.
Department of Public Health, National Cheng Kung University Medical College, Tainan, Taiwan; Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan. Electronic address:



End-stage renal disease (ESRD) may increase the likelihood of malignancy. The aim of this study is to evaluate the characteristics of increased urothelial cancer (UC) risk in patients with ESRD in Taiwan by a population-based study.


The standardized incidence ratios (SIRs) for UC among a registered cohort of ESRD in Taiwan during 1997-2002 were calculated using reimbursement data obtained from the Bureau of National Health Insurance (NHI), with the incidence rates of UC in the general population as the reference.


During the study period we identified 58,739 patients with ESRD, 20,939 patients with UC, and 1305 patients with ERSD and UC. Among the 1305 patients with both diseases, 687 developed UC after ESRD had been diagnosed. Using the general population as the reference group, SIRs were 12.9 [95% confidence interval (CI)]: 12.0-13.9) for all UC cases, 13.9 (95% CI: 12.4-15.0) for bladder cancer, 11.9 (95% CI: 8.6-16.0) for renal cell carcinoma, and 11.6 (95% CI: 10.1-13.1) for upper tract urothelial cancer.


Patients with ESRD are at increased risk for UC in Taiwan, especially women age 50 years and younger. Early and lifelong surveillance of UC is recommended after diagnosis of ESRD.


end-stage renal disease; standardized incidence ratio; upper tract urothelial cancer; urothelial cancer

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