Indicator Details — Emerging Topics: Cancer Incidence by Albumin to Creatinine Ratio (ACR) Quintilea
Data Sources
 
Stratification and Year Choices:

  Source
  • Norwegian Tromso Study

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Footnotes:
a ACR, Albumin to creatinine ratio;BMI, body mass index;
Adjusted for age, gender, BMI, and smoking status.
 




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. An older study on the basis of the Norwegian Tromsø Study examined levels of albuminuria. Associations were either weak or absent with earlier stages of CKD, and there was substantial variability by site of the cancer. In summary, the risk of cancer associated with earlier stages of CKD is modest and appears to be limited to specific cancer sites, most notably renal and bladder cancers. 
Chart Explanation: Adjusted for age, gender, body mass index, inactivity, and smoking status, the risk of any cancer was increased significantly for patients with the highest category of albuminuria of 1.1-24.8 mg/mmol (Relative Risk 1.6; 95%CI: 1.2-2.0, reference group 0 ≤ ACR < 0.34 ). By site of cancer, there was an increased risk of lung cancer in patients in the highest category of albuminuria (HR 2.4; 95%CI: 1.1-5.5).  There was also a significantly increasing risk of bladder cancer with increasing levels of albuminuria (p for trend <0.001) and a similar trend for renal cell cancers, though not significant (p for trend 0.07).  
The Tromsø Study is a population-based, longitudinal study with repeated health surveys of inhabitants in the municipality of Tromsø, Norway. Originally a cardiovascular study, it now focuses on several chronic and lifestyle-related conditions such as atherosclerosis and diabetes. The regional ethical committee approved the study, and the participants have given informed consent. At the fourth survey in 1994/1995, all inhabitants aged 55 to 74 yr and 5 to 10% random samples of the other 5-yr birth cohorts older than 24 yr were invited to participate in the survey. In the age groups 25 to 54, 55 to 74, and 75 to 84 yr, 1751, 7158, and 148 individuals were eligible for measurement of albuminuria and 1205, 5617, and 80, respectively, participated (76% of the eligible population).
FieldData
Description of MeasureCancer incidence by albumin to creatinine ratio (ACR) quintile
Data SourceThe Tromsø Study 
Type of Data SourceLiterature review
Data SetThe Tromsø Study is a population-based, longitudinal study with repeated health surveys of inhabitants in the municipality of Tromsø, Norway. Originally a cardiovascular study, it now focuses on several chronic and lifestyle-related conditions such as atherosclerosis and diabetes. The regional ethical committee approved the study, and the participants have given informed consent. At the fourth survey in 1994/1995, all inhabitants aged 55 to 74 yr and 5 to 10% random samples of the other 5-yr birth cohorts older than 24 yr were invited to participate in the survey. In the age groups 25 to 54, 55 to 74, and 75 to 84 yr, 1751, 7158, and 148 individuals were eligible for measurement of albuminuria and 1205, 5617, and 80, respectively, participated (76% of the eligible population). Among the 6902 individuals who attended the examination, 110 either withdrew their data or had missing measurements of the ACR. 239 individuals were excluded who reported diabetes and/or use of medication for diabetes, 851 with bacteriuria or hematuria on any day
when urine samples were collected or macroalbuminuria (ACR > 25 mg/mmol), and 277 who had a diagnosis of cancer before this survey took place. Thus, 5425 individuals were included in these analyses.
Health Care System DataNo
Regional or NationalInternational
Demographic GroupIndividuals ages 25 years to 84 years, with no prior diagnosis of cancer.
NumeratorIndividuals with cancer at different ACR levels
DenominatorAll individuals selected for the Tromsø Study.
Definition of CKDAlbuminuria (Albumin to creatinine ratio) was used as a marker of CKD.
Primary Data Source IndicatorAlbumin to creatinine ratio
Primary Indicator Method of MeasurementUrine samples from the first morning urine from three consecutive
days were used to assess microalbuminuria. Albumin and creatinine were
measured by turbidimetry on a Cobas Mira S with kits from ABX Diagnostics
(Parc Euromedecine, Montpellier, France). The ACR (mg albumin/
mmol creatinine) was computed, and the mean of the three ratios
was used in the analyses. The between-assay coefficient of variation for all
determinations of albumin, creatinine, and the ACR was<4% throughout
the range of concentrations. Serum creatinine was measured by the
HiCo Creatinine Jaffe´ method with a kinetic colorimetric assay on automated
clinical chemistry analyzers (Boehringer-Mannheim, Mannheim,
Germany), and estimated GFR was calculated using the abbreviated
(four-variable) Modification of Diet in Renal Disease equation.
Frequency of MeasurementOne time.
References and Sources:
Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd