Association of CKD and Cancer Risk in Older People

Abstract

People with ESRD are at increased risk for cancer, but it is uncertain when this increased risk begins in the spectrum of chronic kidney disease (CKD). The aim of our study was to determine whether moderate CKD increases the risk for cancer among older people. We linked the Blue Mountains Eye Study, a prospective population-based cohort study of 3654 residents aged 49 to 97 yr, and the New South Wales Cancer Registry. During a mean follow-up of 10.1 yr, 711 (19.5%) cancers occurred in 3654 participants. Men but not women with at least stage 3 CKD had a significantly increased risk for cancer (test of interaction for gender P ϭ 0.004). For men, the excess risk began at an estimated GFR (eGFR) of 55 ml/min per 1.73 m 2 (adjusted hazard ratio [HR] 1.39; 95% confidence interval [CI] 1.00 to 1.92) and increased linearly as GFR declined. For every 10-ml/min decrement in eGFR, the risk for cancer increased by 29% (adjusted HR 1.29; 95% CI 1.10 to 1.53), with the greatest risk at an eGFR Ͻ40 ml/min per 1.73 m 2 (adjusted HR 3.01; 95% CI 1.72 to 5.27). The risk for lung and urinary tract cancers but not prostate was higher among men with CKD. In conclusion, moderate CKD (stage 3) may be an independent risk factor for the development of cancer among older men but not women, and the effect of CKD on risk may vary for different types of cancer.

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.…”

“…[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. 14 Higher albumin-to-creatinine ratio has also been reported to be associated with a higher incidence of cancer (especially bladder and renal cancer) in adjusted analyses.…”

“…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.…”

Cancer in the Transplant Recipient

“…The relative risk of a patient with chronic kidney disease developing cancer is increased with a glomerular filtration rate (GFR) of ,50 mL/min, men having a 29% increase in cancer risk for every 10 mL reduction in GFR (Wong et al 2009a). The incidence of cancer is also increased in patients who are commenced on dialysis therapy.…”