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Incidence and risk factors for HPV-associated cancers in women with end-stage renal disease
  1. Joan Han1,
  2. Jennifer L Waller2,
  3. Rhonda E Colombo1,
  4. Vanessa Spearman1,
  5. Lufei Young1,
  6. Mufaddal F Kheda1,
  7. Azeem Mohammed1,
  8. Wendy B Bollag3,
  9. Norris Stanley Nahman1,
  10. Stephanie L Baer1,4
  1. 1 Department of Medicine, Medical College of Georgia, Augusta, Georgia, USA
  2. 2 Department of Population Health Sciences, Medical College of Georgia, Augusta, Georgia, USA
  3. 3 Department of Dermatology, Medical College of Georgia, Augusta, Georgia, USA
  4. 4 Infection Control and Epidemiology, Augusta VA Medical Center, Augusta, Georgia, USA
  1. Correspondence to Dr Stephanie L Baer, Department of Medicine, Medical College of Georgia, Augusta, GA 30904, USA; stephanie.baer{at}


Human papillomavirus (HPV) causes the majority of cervical, anal/rectal, and oropharyngeal cancers in women. End-stage renal disease (ESRD) is also associated with an increased risk of malignancy, but the incidence of and risk factors for HPV-associated cancers in US dialysis patients are not defined. We queried the US Renal Data System for women with HPV-associated cancers and assessed for incidence of cancer diagnosis and association of risk factors. From 2005 to 2011, a total of 1032 female patients with ESRD had 1040 HPV-associated cancer diagnoses. Patients had a mean age of 65 years, were mostly white (63%), and on hemodialysis (92%). Cervical cancer (54%) was the most common, followed by anal/rectal (34%), and oropharyngeal (12%). The incidence of HPV-associated cancers in patients with ESRD increased yearly, with up to a 16-fold increased incidence compared with the general population. Major risk factors associated with the development of any HPV-associated cancer included smoking (adjusted relative risk=1.89), alcohol use (1.87), HIV (2.21), and herpes infection (2.02). Smoking, HIV, and herpes infection were prominent risk factors for cervical cancer. The incidence of HPV-associated cancers in women with ESRD is rising annually and is overall higher than in women of the general population. Tobacco use is a universal risk factor. For cervical cancer, the presence of HIV and herpes are important comorbidities. Recognizing risk factors associated with these cancers may improve diagnosis and facilitate survival. The role of HPV vaccination in at-risk dialysis patients remains to be defined but warrants further study.

  • cancer
  • kidney failure, chronic
  • risk
  • genital diseases, female
  • tobacco

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  • Presented at Presented at the Southern AFMR (oral).

  • Contributors The lead author (JH), senior author (SLB), and authors REC and NSN conceived the study and developed the study design, along with additional critical contributions from JLW, VS, LY, and MFK. JLW performed data extraction and statistical analysis. JH drafted the manuscript. JLW, REC, VS, LY, MFK, AM, WBB, NSN, and SLB contributed to data analysis and interpretation, as well as reviewed and revised the final manuscript and figures. All authors have approved the final version of the manuscript to be published and agree to be accountable for all aspects of the work.

  • Funding This study was supported by Augusta University Medical Scholars Program (JH), a grant from Dialysis Clinic (MFK and NSN), and the Translational Research Program of the Department of Medicine, Augusta University.

  • Disclaimer The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as official policy or interpretation of the US government. The contents do not represent the views of the Department of Veterans Affairs or the US government.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was not required for this study. The data reported here have been supplied by the US Renal Data System (USRDS).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The USRDS is a deidentified patient database that includes demographic characteristics, dialysis claims, transplant history, payer source, hospitalization, physician/supplier claims (including ICD-9 and CPT diagnosis codes) and vital statistics on all patients with ESRD in the USA. Demographic information was available in the USRDS patient information data set, and comorbidities were defined by inpatient ICD-9 billing codes submitted to Medicare. The latest version of the form CMS-2728, implemented in 2005, was used to obtain information about age at the start of dialysis, race, ethnicity, mode of dialysis, and vascular access type on first dialysis.