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. 2024 Oct 30;39(11):1799-1808.
doi: 10.1093/ndt/gfae059.

Sex differences in cancer outcomes across the range of eGFR

Richard Shemilt  1   2 , Michael K Sullivan  1   3 , Peter Hanlon  4 , Bhautesh D Jani  4 , Nicole De La Mata  5 , Brenda Rosales  5 , Benjamin M P Elyan  1   3 , James A Hedley  5 , Rachel B Cutting  5 , Melanie Wyld  5 , David A McAllister  4 , Angela C Webster  5   6 , Patrick B Mark  1   3 , Jennifer S Lees  1   3
Affiliations

Sex differences in cancer outcomes across the range of eGFR

Richard Shemilt et al. Nephrol Dial Transplant. .

Erratum in

  • Correction.
    [No authors listed] [No authors listed] Nephrol Dial Transplant. 2025 May 30;40(6):1261. doi: 10.1093/ndt/gfae219. Nephrol Dial Transplant. 2025. PMID: 39436739 Free PMC article. No abstract available.

Abstract

Background: People with chronic kidney disease (CKD) have increased incidence and mortality of most cancer types. We hypothesized that the odds of presenting with advanced cancer may vary according to differences in estimated glomerular filtration rate (eGFR), that this could contribute to increased all-cause mortality and that sex differences may exist.

Methods: Data were from Secure Anonymised Information Linkage Databank, including people with de novo cancer diagnosis (2011-17) and two kidney function tests within 2 years prior to diagnosis to determine baseline eGFR (mL/min/1.73 m2). Logistic regression models determined the odds of presenting with advanced cancer by baseline eGFR. Cox proportional hazards models tested associations between baseline eGFRCr and all-cause mortality.

Results: eGFR <30 was associated with higher odds of presenting with advanced cancer of prostate, breast and female genital organs, but not other cancer sites. Compared with eGFR >75-90, eGFR <30 was associated with greater hazards of all-cause mortality in both sexes, but the association was stronger in females [female: hazard ratio (HR) 1.71, 95% confidence interval (CI) 1.56-1.88; male versus female comparison: HR 0.88, 95% CI 0.78-0.99].

Conclusions: Lower or higher eGFR was not associated with substantially higher odds of presenting with advanced cancer across most cancer sites, but was associated with reduced survival. A stronger association with all-cause mortality in females compared with males with eGFR <30 is concerning and warrants further scrutiny.

Keywords: cancer; chronic kidney disease; cohort studies; female; male.

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Conflict of interest statement

Outside the submitted work, J.S.L. has received personal lectureship honoraria from AstraZeneca, Pfizer and Bristol Myers Squibb. P.B.M. reports lecture honoraria from AstraZeneca, Pharmacomsos, Astellas, GSK and Boehringer Ingelheim outside the submitted work.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
(A) Plot displaying OR (95% CI) of presentation with advanced cancer, adjusted for age, smoking status, deprivation status, number of comorbidities and cancer site. (B) Plot displaying HR (95% CI) of death after cancer diagnosis, adjusted for age, smoking status, deprivation status, number of comorbidities, cancer site and presenting cancer stage. Results are stratified by sex. Asterisk indicates presence of a significant interaction between sex and eGFR category. Reference eGFR category: 75–<90 mL/min/1.73 m2.
Figure 2:
Figure 2:
Plot displaying OR (95% CI) of presentation with advanced (stage 3 or 4) site-specific cancer. Models are adjusted for age, sex, smoking status, deprivation status and number of comorbidities. Results are stratified by sex and cancer site. Asterisk indicates presence of a significant interaction between sex and eGFR category.
Figure 3:
Figure 3:
Plot displaying HR (95% CI) of death (any cause) after site-specific cancer diagnosis. Models are adjusted for age, sex, smoking status, deprivation status, number of comorbidities and presenting cancer stage. Results are stratified by sex and cancer site. Asterisk indicates presence of a significant interaction between sex and eGFR category.
See this image and copyright information in PMC

References

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