Prior studies have shown that end-stage renal disease is associated with an increased risk of a variety of cancers. Now, reporting at the Genitourinary Cancers Symposium, William T. Lowrance, MD, MPH, from the Huntsman Cancer Institute and colleagues found that chronic kidney disease is significantly associated with an increased risk of renal and urothelial cancer (Abstract 351).
The meeting is co-sponsored by ASCO, ASTRO, and the Society of Urologic Oncology.
To assess the potential association, the team, also from Memorial Sloan-Kettering Cancer Center and Kaiser Permanente, examined data from nearly 1.2 million individuals (1,190,538) insured by Kaiser who underwent at least one outpatient, non-emergency serum creatinine measurement between 2000 and 2008. Of those, 72,875 were diagnosed with 76,809 incident cancers during a median follow-up of 5.3 years (6,000,420 person-years).
The results showed that as an individual's estimated glomerular filtration rate (eGFR) declined, there was a step-wise increase in the risk of renal cancer, even after adjusting for age, gender, race, socioeconomic status, comorbidities, proteinuria, body mass, smoking status, health care utilization, and specific prescription drugs.
The adjusted hazard ratio for renal cancer was 1.35 for individuals with an eGFR of 45-59 ml/min/1.73 m2 compared with individuals with an eGFR of 60-89 ml/min/1.73 m2, 1.65 for individuals with an eGFR of 30-44 ml/min/1.73 m2, and 2.09 for individuals with an eGFR below 30 ml/min/1.73 m2.
Similarly, the risk of urothelial cancer was significantly higher in individuals with an eGFR between 30-44 ml/min/1.73 m2 and below 30, compared with individuals with an eGFR of 60-89 (hazard ratio of 1.40 and 1.35, respectively). There was no association between eGFR and the risk of lung, breast, or prostate cancers or with any cancer.
Currently, approximately 13.5 million Americans have stage 3 or worse chronic kidney disease (eGFR of 59 ml/min/1.73 m2 or lower). Lowrance said that given the significant relationship between the chronic disease and renal cancer risk, that eGFR may be a useful way to identify individuals for renal cancer screening. However, he emphasized that prospective studies would be needed to demonstrate the net clinical benefit of the approach.