Chronic kidney disease and incident cancer risk: an individual participant data meta-analysis
Yejin Mok, Aditya Surapaneni, Yingying Sang, Josef Coresh, Morgan E. Grams, Kunihiro Matsushita, Shoshana H. Ballew, Natalia Alencar de Pinho, Johan Ärnlöv, Sandhi Maria Barreto, Samira Bell, Hermann Brenner, Juan Jesús Carrero, Rajkumar Chinnadurai, Elizabeth L. Ciemins, Ron T. Gansevoort, Simerjot K Jassal, Keum Ji Jung, H. Lester Kirchner, Tsuneo Konta, Csaba P. Kövesdy, Li Luo, Krutika Pandit, Mahboob Rahman, Cassianne Robinson‐Cohen, Charumathi Sabanayagam, Ulla T. Schultheiß, Michael G. Shlipak, Natalie Staplin, Marcello Tonelli, Angela Yee‐Moon Wang, Chi Pang Wen, Mark Woodward, Jennifer S. Lees, ADVANCE, Katie Harris, Hisatomi Arima, John Chalmers, ARIC, Morgan E. Grams, BioVu, Elvis A. Akwo, Jing He, CARE, Anita Lloyd, CKD-REIN, Natália Alencar de Pinho, Marie-Hélène Metzger, Bénédicte Stengel, Aghilès Hamroun, Ziad A. Massy, CRIC, Panduranga S. Rao, Nestor Sosa, Vallabh O. Shah, Jesse Y. Hsu, ELSA-Brasil, Álvaro Vigo, José Geraldo Mill, Paulo A. Lotufo, Scheine Canhada, ESTHER, Ben Schöttker, Hannah Stocker, Dietrich Rothenbacher, GCKD, Markus P. Schneider, Anna Köttgen, Heike Meiselbach, Kai‐Uwe Eckardt, Geisinger, Jamie Green, Alex R. Chang, Gurmukteshwar Singh, Go-DARTS, Emilie Lambourg, Shona Livingstone, Colin Palmer, Ewan R. Pearson, KCPS-II, Sun Ha Jee, Heejin Kimm, MESA, Ronit Katz, NYU, Carina Flaherty, OLDW, Jeff T. Mohl, PREVEND, Lyanne M. Kieneker, Stephan J. L. Bakker, Bert van der Vegt, Rudolf A. de Boer, Rancho Bernardo, Jaclyn Bergstrom, Joachim H. Ix, RCAV, Keiichi Sumida, Prabin Shrestha, SEED
Abstract
BACKGROUND: Studies examining the association of chronic kidney disease (CKD) with cancer risk have demonstrated conflicting results. METHODS: This was an individual participant data meta-analysis including 54 international cohorts contributing to the CKD Prognosis Consortium. Included cohorts had data on albuminuria [urine albumin-to-creatinine ratio (ACR)], estimated glomerular filtration rate (eGFR), overall and site-specific cancer incidence, and established risk factors for cancer. Included participants were aged 18 years or older, without previous cancer or kidney failure. RESULTS: Among 1,319,308 individuals, the incidence rate of overall cancer was 17.3 per 1000 person-years. Higher ACR was positively associated with cancer risk [adjusted hazard ratio 1.08 (95% CI 1.06-1.10) per 8-fold increase in ACR]. No association of eGFR with overall cancer risk was seen. For site-specific cancers, lower eGFR was associated with urological cancer and multiple myeloma, whereas higher ACR was associated with many cancer types (kidney, head/neck, colorectal, liver, pancreas, bile duct, stomach, larynx, lung, hemolymphatic, leukaemia, and multiple myeloma). Results were similar in a 1-year landmark analysis. DISCUSSION: Albuminuria, but not necessarily eGFR, was independently associated with the subsequent risk of cancer. Our results warrant an investigation into mechanisms that explain the link between albuminuria and cancer.