Association of cancer with moderately impaired renal function at baseline in a large, representative, population-based cohort followed for up to 30 years

Abstract

Patients with chronic renal failure show a greater incidence of malignancies. We evaluated whether moderately impaired renal function at baseline influenced risk of all cancers during long-term follow in young persons. Our cohort included 33,346 subjects, aged 26–61 years at baseline, in a representative, population-based study enrolling subjects from 1974 to 1992. Median follow-up time was 28 years. Plasma creatinine was analysed as a single measure at baseline. Incident cases of cancer were identified from the Swedish Cancer Registry. We studied 24,552 subjects from the cohort. To account for the unique sampling design, participants were divided by sex and age at baseline into 1,132 older men (age 60), 14,254 younger men (age 40–52), 7,498 older women (age 47–57) and 1,688 younger women (age 35–43). Glomerular filtration rate (GFR) was estimated using the CKD-EPI formula. Patients were classified as having either normal to mildly impaired kidney function (eGFR≥60 mL/min/1.73m2), or moderate kidney dysfunction (eGFR<60 mL/min/1.73m2). We calculated the risk of all cancers using competing risks regression. Overall, 6,595 participants were diagnosed with cancer, and 854 subjects (3.5%) had moderately impaired renal dysfunction at baseline. There was a significant association between moderately decreased GFR and subsequent risk of kidney cancer in younger men (hazard ratio, 3.38; 95% CI, 1.48 to 7.71; P=0.004). However, we found no association with overall long-term cancer risk. Our confirmation of an association between moderately impaired renal function and risk of kidney cancer in younger men requires further exploration of high-risk groups and biological mechanisms.

CKD and the Risk of Incident Cancer

“…[12][13][14][15] In contrast to our findings, two prior studies found an association between renal function and overall cancer risk, 13,14 whereas another study found no association between CKD and cancer risk in diabetic patients. 15 When focusing on specific cancer types, three studies found that lower kidney function was associated with higher risks of renal and urothelial cancer and support our findings.…”

“…15 When focusing on specific cancer types, three studies found that lower kidney function was associated with higher risks of renal and urothelial cancer and support our findings. [12][13][14] In a cohort of approximately 3600 participants, men had a significantly increased risk of cancer with lower GFR; stage 3 CKD was an independent risk factor for cancer, and this risk increased in a linear fashion with lower baseline eGFR. 14 The relation between kidney function and cancer risk was site-specific, with the most robust association seen with urinary tract (excluding prostate) and lung cancers.…”

“…Although multiple studies have observed higher risks of cancer in persons with ESRD requiring dialysis or renal transplantation, [4][5][6][7][8][9][10][11] whether less severe kidney disease is associated with cancer remains poorly understood. [12][13][14][15] Previous studies are limited by modest sample sizes, restricted diversity, and their ability to adequately control for confounders. Determining whether there is a robust association between the presence and severity of CKD with subsequent cancer risk and specifically examining if level of kidney function is differentially associated with specific cancer type could have important public health implications for screening and early detection of cancer in patients with CKD.…”

Factors Associated with Recovery of Renal Function following Radical Nephrectomy for Kidney Neoplasms

“…A recent study found that surgically induced CKD was not a significant predictor of survival in patients without preexisting CKD and that annual functional renal decline was only 0.7% in patients with surgically induced CKD, compared with 4.7% in patients with preexisting CKD (19). The patients with surgically induced CKD did not have the additional medical comorbidities or preexisting CKD, which may be etiologic factors in the development of kidney and urothelial cancers and can be considered a healthier cohort, more akin to the kidney donor population than the average patient with kidney tumor (20,21).…”

Alterations in Serum MicroRNA Profile During Hemodialysis - Potential Biological Implications

“…Cancer development is another risk in ESRD patients. The risk of renal cancer development can be up to three-fold higher compared to patients from general population without ESRD [6][7][8]30]. Another cause of malignancy in patients undergoing hemodialysis may be metabolic changes or immune dysfunction induced by dialysis [7].…”