Chemotherapy-induced changes in blood indices among chronic dialysis patients: A nationwide study.

Abstract

e24122 Background: End-stage renal disease (ESRD) patients often experience compromised bodily function, erythropoietin deficiency, and altered bone marrow activity. Several studies have reported an increased risk of cancers in ESRD patients. These factors, combined with the toxicity of chemotherapy (chemo), may lead to changes in blood cell counts, including white cells, red cells, hemoglobin, and platelets aggravating pre-existing abnormalities. The aim of this study is to evaluate the independent effect of chemo on blood cell counts in patients undergoing chronic dialysis. Methods: A retrospective analysis was conducted using the National Inpatient Sample database from 2016 to 2020, with ICD-10 codes used to identify patients undergoing chronic dialysis. The study assessed the effect of chemo on blood cell counts in these patients. Categorical variables were compared using the chi-square test. Multivariate analysis, adjusted for confounders, was performed to derive odds ratios, with p<0.05 set as the threshold for statistical significance. Results: A total of 5,549,620 ESRD hospitalizations were identified, with 0.04% of these patients undergoing chemo. The mean age of ESRD patients undergoing chemo was 60 years, compared to 62 years for those not receiving chemo, and 38.92% of chemo patients with ESRD were female (p=0.003). The racial distribution was 44% White, 35% Black, and 12% Hispanic (p=0.13). After adjusting for confounders, ESRD patients undergoing chemotherapy had higher odds of resource utilization and worse impact on blood counts compared to those not receiving chemotherapy, while effect on mortality was not statistically significant (Table). Conclusions: Our study highlights the significant challenges faced by chronic dialysis patients undergoing chemo, where the myelosuppressive effects of treatment exacerbate hematological complications of ESRD, leading to increased morbidity and resource use. The study emphasizes the need for a multidisciplinary approach to balance cancer treatment efficacy with the management of hematological and dialysis-related complications, however prospective studies are essential to establish causation. Chemotherapy-induced changes in blood indices among chronic dialysis patients: a nationwide study. Outcomes with chemo(%) without chemo (%) *Adjusted Odds Ratio 95% Confidence Interval P value Anemia 82.66 76.04 1.54 1.22-1.94 <0.001 Thrombocytopenia 13.87 9.49 1.53 1.17-2.00 0.002 Resource utilization Mean length of stay (days) 8.2 6.8 3.39 1.32-8.67 0.01 Total charges ($) 113506 89983 **21039 5955-36123 0.006