Adequate Estimation of Tumor Markers in Hemodialysis (HD) Patients

The purpose of this study is to clarify clinical characteristics affecting the serum levels of tumor markers, consequently to evaluate the levels of the markers adequately in HD patients. One hundred and twelve HD patients (68 males and 44 females) with clinically no malignancies were subjected to this study. Serum CEA, AFP, CA19-9 in males and females as well as those of PSA in males and SCC in females were measured and investigated a relationship to clinical features of age, duration of HD therapy, and primary kidney diseases which caused end stage renal disease (ESRD). Serum levels of CEA, AFP, CA19-9, PSA and SCC in the HD patients were 4.9±0.4 ng/ml, 3.0±0.2 ng/ml, 13.3±1.4 U/ml, 1.2±0.1 ng/ml and 4.5±1.1 ng/ml, respectively (mean±SEM). The mean CEA level in HD patients were within the normal range (≤5.0 ng/ml), however, 33% of HD patients showed higher CEA levels than the normal range. No HD patient showed a higher AFP level than the normal range (≤10 ng/ml) and a positive correlation between AFP levels and HD duration was found suggesting an accumulation of AFP molecule over time. Patients with chronic glomerulonephritis (CGN) patients (3.5±1.7 ng/ml) showed higher AFP levels than those with diabetic nephropathy (DN) patients (2.5±1.6 ng/ml). CA19-9 levels in 96.4% of HD patients were within the normal range (≤37 U/ml) and those in DN patients (16.0±2.3 U/ml) showed twice as high as those in CGN patients (8.2±1.2 U/ml). Within the normal range (≤4.0 ng/ml), mean PSA levels significantly elevated according to aging by every decade. A positive correlation between serum SCC and creatinine levels indicated an impaired clearance of SCC molecule may elevate serum SCC levels. In summary, normal ranges of AFP and CA19-9 are applicable to HD patients, although one-third of HD patients show higher CEA levels than the normal range. Relevant consideration of HD duration and primary diseases of ESRD for AFP, while primary diseases of ESRD for CA19-9, ages for PSA and serum creatinie levels for SCC may be indispensable for adequate estimation of these markers.