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 = 0.004). For men, the excess risk began at an estimated GFR (eGFR) of 55 ml/min per 1.73 m2 (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 <40 ml/min per 1.73 m2 (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.

Figure 1.

Cumulative incidence of cancers in men, stratified by eGFR.

Figure 2.

Cumulative incidence of cancers in women, stratified by eGFR.

Figure 3.

Adjusted HRs for incident cancers across continuous measures of eGFR before and after adjustment for measurement errors in men.

Figure 4.

Adjusted HRs for incident cancers across various thresholds of eGFR in both men and women.

Figure 5.

Adjusted HR for all sites and site-specific cancers by gender. ¶Adjusted for the effect of age, smoking status, sun-related skin damage, and DBP in men. #Adjusted for the effect of age, smoking status, and sun-related skin damage in women. *Unable to calculate HRs for urinary tract cancers in women with CKD and for melanoma in women and men with eGFR <40 ml/min per 1.73 m². There were insufficient numbers of cancers at the threshold below the designated eGFR.