JAMA Netw Open

High doses of erythropoiesis stimulating agents tied to increased cancer risk in dialysis patients

March 4, 2026

A Korean case-control study of nearly 10,000 dialysis patients found that high-dose erythropoiesis-stimulating agent (ESA) use was associated with a 23% increased odds of developing cancer compared with low-dose use (adjusted odds ratio [aOR], 1.23; 95% confidence interval [CI], 1.11-1.35). The association was particularly pronounced in patients aged 60 years or older, who had 47% higher odds of cancer development (OR, 1.47; 95% CI, 1.30-1.67), while no significant association was observed in younger patients. The findings remained consistent across different comorbidities, dialysis modalities, and ESA types.

Clinical takeaway: Use the lowest effective ESA dose and avoid targeting high hemoglobin levels, especially in older adults on long‑term dialysis.

Source:

Kim JY, et al. (2026, February 2). JAMA Netw Open. Erythropoiesis-Stimulating Agents and Development of Cancer Among Patients Receiving Dialysis. https://pubmed.ncbi.nlm.nih.gov/41758511/