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김형우Hyung Woo Kim

연세대학교 의과대학 내과학교실

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JAMA Netw. Open, Feb 02 2026, 9 (2) e260140 | https://doi.org/10.1001/jamanetworkopen.2026.0140 Erythropoiesis-Stimulating Agents and Development of Cancer Among Patients Receiving Dialysis

Jae Young Kim, MD, PhD^1,2; Jae Kwang Lee, MHA³; Tae Ik Chang, MD, PhD¹; Hyung Woo Kim, MD^2,4

¹Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
²Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
³Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
⁴Yonsei Institute for Digital Healthcare, Yonsei University, Seoul, Republic of Korea

Drs Chang and H.W. Kim contributed equally to this work.
Corresponding Author: Hyung Woo Kim, MD

Abstract

Importance: Although erythropoiesis-stimulating agents (ESAs) are widely used to treat anemia in patients with kidney failure, concerns have been raised about their potential to promote tumor growth. However, the association between ESA use and incidence of cancer in patients undergoing long-term dialysis remains unclear.

Objective: To examine the association between ESA use and cancer development among patients receiving long-term dialysis.

Design, setting, and participants: This nested case-control study identified patients in the Korean National Health Insurance Service database with kidney failure who began long-term dialysis treatment and received ESAs between 2006 and 2017 in Korea. Each case with incident cancer was matched with 4 controls based on age, sex, follow-up time, year of dialysis initiation, and dialysis modality. Data were analyzed between August 2024 and August 2025.

Exposure: ESA exposure was categorized as high or low dose according to the median of the mean weekly dose of each ESA drug.

Main outcomes and measures: The primary outcome was newly diagnosed cancer occurring 6 months after the initiation of long-term dialysis. Conditional logistic regression, adjusted for potential confounders, was used to assess the association between ESA use and cancer development.

Results: A total of 9776 patients (mean [SD] age, 62.2 [12.0] years; 6296 [64.4%] male) undergoing dialysis were included; 2320 patients with incident cancer were matched to 7456 controls. After multivariable adjustment, high-dose ESA use was found to be associated with increased odds of cancer development (adjusted odds ratio, 1.23; 95% CI, 1.11-1.35) compared with low-dose use. Stratified by age, the odds of cancer development were 0.90 (95% CI, 0.77-1.05) among patients aged younger than 60 years and 1.47 (95% CI, 1.30-1.67) among those aged 60 years or older.

Conclusions and relevance: In this case-control study of patients undergoing dialysis, high-dose ESA use was associated with greater odds of new cancer development. These results suggest that caution should be exercised to avoid aiming for excessively high hemoglobin levels during ESA therapy.

논문소개전체 설명

국내에서 투석 치료를 유지 중인 말기 신부전 환자들을 대상으로 한 사례-대조 연구(nested case-control study)를 진행하였고, 적혈구 생성 자극제(erythropoiesis-stimulating agent, ESA)의 고용량 사용이 새로운 암 발생 위험 증가와 연관성을 가짐을 확인하였습니다. 이러한 결과는 ESA 치료 중 과도하게 높은 헤모글로빈 수치를 목표로 삼지 않도록 주의해야 함을 시사한다고 할 수 있습니다.

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