There is ongoing interest in the relationship between chronic kidney disease (CKD) and cancer. Although it is well known that some malignancies may contribute to kidney dysfunction (e.g., multiple myeloma), it is less clear whether CKD, particularly in its earlier stages, contributes to the development of cancer. A recent meta-analysis of data from one cohort study and five clinical trials examined the effect of various levels of estimated glomerular filtration rate (eGFR). Associations were either weak or absent with earlier stages of CKD, and there was substantial variability by site of the cancer.
Chart Explanation: After adjusting for age, sex, race and smoking status, the relative risk of any cancer was not increased significantly for any range of eGFR. By site of cancer, there were significant increases in risk for urinary tract tumors for patients with eGFR < 45 mL/min/1.73 m2 (Hazard Ratio [HR] 1.7; 95% Confidence Interval (CI): 1.0-2.7) and those on dialysis (HR 2.3; 95%CI: 1.3-4.2).
Six studies were included in our analysis, of which one was a prospective, population-based cohort study, and five were randomized controlled trials (RCTs). These studies were included because they provided details of
serum creatinine, age and gender for the estimation of glomerular filtration rate (GFR), as well as information on site-specific and overall cancer incidence and mortality. Information on non-cancer related mortality was
also recorded. All studies were also available to the investigator team for inclusion and so represent a sample of all possible datasets available for analysis.
|Description of Measure||Cancer incidence by eGFR categories|
|Data Source Long Name||Meta-analysis based on one cohort study and five clinical trials.|
|Type of Data Source||Literature review|
|Data Source Short Name||Clinical Trials|
|Data Source Description||Six studies, including one population based cohort and five randomized controled trials.|
|Health Care System Data||No|
|Regional or National||National|
|Definition of CKD||Status of CKD was defined based on CKD EPI-estimated GFR (ml/min/1.73m2) cut off points as follows:|
eGFR ≥ 75 ml/min/1.73m2
60 ≤ eGFR < 75ml/min/1.73m2
45 ≤ egfr < 60 ml/min/1.73m2
eGFR < 45 ml/min/1.73m2
|Glomerular Filtration Rate||Estimated, CKD-EPI definition|
|Primary Data Source Indicator||Incidence of cancer by CKD|
|Primary Data Source Indicator||CKD status by eGFR|
|Period Current Available||n/a|
|Frequency of Measurement||One time|
|Data Set||The cohort study was the Blue Mountains Eye Study (BMES), which included a suburban Australian population aged 49 years or older at baseline (n = 3654). The other five RCTs included the Action in Diabetes and Vascular disease: Preterax and Diamicron MR controlled evaluation (ADVANCE) study, a multi-centre trial of blood pressure lowering and glucose control in people with type 2 diabetes mellitus (n = 11,140); the Perindopril-based blood-pressure-lowering regimen (PROGRESS) study, a multi-centre trial of intensive blood pressure lowering using the mixed perindopril and indapamide and placebo in patients with a history of stroke or transient ischaemic attack (n = 6105); the Calcium Intake Fracture Outcome (CAIFOS) study, a trial of 1500 women that assessed the effects of daily calcium supplements and the risk of osteoporotic fractures in post-menopausal women; the Study of Heart and Renal Protection (SHARP), a multi-centre trial of LDL cholesterol lowering in people with CKD (n = 9270) and the Initiating Dialysis Early and Late Study (IDEAL), a trial that compared early and later commencement of dialysis in patients with ESKD (n = 828). Full details of each study are reported elsewhere.|