Kidney function and cancer risk: An analysis using creatinine and cystatin C in a cohort study
Jennifer S. Lees, Frederick K. Ho, Solange Parra‐Soto, Carlos Celis‐Morales, Paul Welsh, Michael Sullivan, Bhautesh Jani, Naveed Sattar, Ninian N. Lang, Jill P. Pell, Angela C Webster, Patrick B. Mark
Abstract
Background: We examined whether an increased risk of cancer incidence and death is associated with kidney function and albuminuria and whether the risk is more readily identified when kidney function is estimated using cystatin C. Methods: Participants were from UK Biobank (recruitment spanning 20072010), excluding those with a prior diagnosis of cancer. Estimated glomerular filtration rate (ml/min/1.73m 2 ) was calculated using creatinine (eGFRcr), cystatin C (eGFRcys) and creatinine-cystatin C (eGFRcr-cys). Cox proportional hazards models tested associations between eGFR, urinary albumin:creatinine ratio (uACR) and cancer incidence and death. Findings: In 431,263 participants over median follow-up of 11.3 (IQR 10.612.0) years, there were 41,745 incident cancers and 11,764 cancer deaths. eGFRcys was most strongly associated with cancer incidence and death (HR 1.04 (95% CI 1.031.04) and 1.06 (1.051.07) per 10 ml/min/1.73m 2 decline, respectively). eGFRcr was not associated with either outcome (incidence: HR 1.00 (1.001.01); death: HR 0.99 (0.981.01) per 10 ml/min/1.73m 2 decline). Relative to eGFRcys>90 or uACR<3 mg/mmol, eGFRcys6089 (HR 1.04 (95% CI 1.021.07)), eGFRcys<60 (HR 1.19 (1.141.24)) and uACR3 mg/mmol (HR 1.09 (1.061.12)) were associated with higher risk of incident cancer. eGFRcys6089 (HR 1.15 (1.101.21)); eGFRcys<60 (HR 1.48 (1.381.59)) and uACR3 mg/mmol (HR 1.17 (1.111.24)) were associated with cancer death. Interpretation: Excess risk of cancer incidence and cancer death is more readily captured in early chronic kidney disease by eGFRcys than by current measures. The association between kidney function, uACR and cancer death in particular is concerning and warrants further scrutiny.