Cancer risk increased for patients with mild to moderate CKD, kidney transplant recipients
Patients with mild to moderate chronic kidney disease or recipients of kidney transplants are at increased risk for cancer, according to data published in the American Journal of Kidney Disease.
“We sought to characterize the burden of cancer diagnoses and cancer deaths among patients with kidney disease and determine whether their risk was increased vs. patients with normal kidney function,” Abhijat Kitchlu, MD, MSc, a staff nephrologist and clinician investigator at the University Health Network and an assistant professor of medicine at the University of Toronto, told Healio. “We also assessed whether patients with kidney disease were found to have more advanced cancer stage when they were diagnosed.”
In a population-based cohort study, researchers evaluated all adults in Ontario, Canada, who had data on eGFR (n=5,882,388) or were receiving maintenance dialysis (n=29,809) or received a kidney transplant between 2007 and 2016 (n=4,951).
Patients underwent two eGFR assessments using the Chronic Kidney Disease Epidemiology Collaboration equation, and researchers categorized them based on Kidney Disease: Improving Global Outcomes stages G1/2, G3a, G3b, G4 and G5.
Researchers followed patients until the first new cancer diagnosis, censoring events or death. Primary outcomes were overall and site-specific cancer incidence and mortality.
Using multivariable Fine and Gray models, researchers measured the correlation between kidney function and cancer incidence. Additionally, researchers used Chi-squared testing to compare cancer stage at diagnosis across kidney function categories.
During 29,993,847 person-years of follow-up, 325,985 cancer diagnoses were made. According to the study, the cumulative incidence of cancer in patients with kidney disease ranged between 10.8% and 15.3%. Researchers identified patients with CKD stages G3a, G3b and G4, and transplant recipients had an increased risk of cancer-specific mortality.
“We found that 10[%] to15% of patients with kidney disease went on to develop cancer, and that risk for cancer was increased in patients with mild to moderate kidney disease. Also, risk of cancer death was higher in patients with mild-moderate kidney disease. Patients with kidney disease had more stage 4 cancers at the time of diagnosis,” Kitchlu told Healio. “This highlights the importance of cancer detection in patients with kidney disease, as well as the need to develop better cancer treatment strategies for those with kidney dysfunction. There is limited evidence to guide modification of cancer therapy in patients with kidney disease, and these patients are often excluded from clinical trials of cancer treatments.”