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Review
. 2023 May 4;38(5):1071-1079.
doi: 10.1093/ndt/gfac011.

The 'other' big complication: how chronic kidney disease impacts on cancer risks and outcomes

Jennifer S Lees  1 , Benjamin M P Elyan  2 , Sandra M Herrmann  3 , Ninian N Lang  1 , Robert J Jones  4 , Patrick B Mark  1
Affiliations
Review

The 'other' big complication: how chronic kidney disease impacts on cancer risks and outcomes

Jennifer S Lees et al. Nephrol Dial Transplant. .

Abstract

Cancer is the second leading cause of death in people with chronic kidney disease (CKD) after cardiovascular disease. The incidence of CKD in patients with cancer is higher than in the non-cancer population. Across various populations, CKD is associated with an elevated risk of cancer incidence and cancer death compared with people without CKD, although the risks are cancer site-specific. Higher risk of cancer is detectable in mild CKD [estimated glomerular filtration rate (eGFR) 60-89 mL/min/1.73 m2], although this risk is more obvious if sensitive markers of kidney disease are used, such as cystatin C. Independent of eGFR, albuminuria is associated with increased risk of site-specific cancer incidence and death. Here, we explore the potential mechanisms for the increased risk of cancer observed in CKD, including patient factors (shared risks such as cardiometabolic disease, obesity, smoking, diet, lifestyle and environment), disease (genetic, inflammatory and infective) and treatment factors. In particular, we discuss the ways in which renal adverse events associated with conventional chemotherapies and newer systemic anti-cancer therapies (including targeted and immunotherapies) may contribute to worse cancer outcomes in people with CKD. Finally, we review the potential benefits of acknowledging increased risk of cancer in risk prediction tools used for the management of CKD.

Keywords: CKD; GFR; cancer; creatinine; cystatin C.

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Conflict of interest statement

Outside the submitted work, J.S.L. reports personal fees from Pfizer, AstraZeneca and Bristol-Myers Squibb; P.B.M. reports personal fees and/or non-financial support from Vifor, Napp, Pharmacosmos, AstraZeneca, Astellas and Novartis, and grants from Boehringer Ingelheim; N.N.L. reports personal fees and non-financial support from Roche, Pfizer, Novartis, AstraZeneca, Pharmacosmos and Vifor Pharma, and grant support from Roche Diagnostics, AstraZeneca and Boehringer (all paid to the University of Glasgow, his employing institution). R.J.J. reports research support from Clovis, Astellas, Exelixis, AstraZeneca and Roche, and honoraria from Clovis, Astellas, AstraZeneca, Roche, Ipsen, Bristol-Myers-Squibb, Pfizer, Merck Serono, Merck Sharp Dohme, Janssen, Bayer and Novartis.

Figures

FIGURE 1:
FIGURE 1:
Patient, disease and treatment factors associated with kidney disease and cancer. HIV, human immunodeficiency virus; HPV, human papillomavirus; EBV, Epstein-Barr virus; CMV, cytomegalovirus; HTLV-1, human T-cell leukemia virus type 1.
FIGURE 2:
FIGURE 2:
Common renal adverse events associated with SACT by site of action. SIADH, syndrome of inappropriate antidiuretic hormone secretion; EGFR, epidermal growth factor receptor.
See this image and copyright information in PMC

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