Estimated glomerular filtration rate and the risk of cancer

Hong Xu, Kunihiro Matsushita, Guobin Su, Marco Trevisan, Johan Ärnlöv, Peter Barany, Bengt Lindholm, Carl Gustaf Elinder, Mats Lambe, Juan Jesus Carrero

Research output: Contribution to journalArticle

Abstract

Background and objectives Community-based reports regarding eGFR and the risk of cancer are conflicting.We here explore plausible links between kidney function and cancer incidence in a large Scandinavian population- based cohort. Design, setting, participants, & measurements In the Stockholm Creatinine Measurements project, we quantified the associations of baseline eGFRwith the incidence of cancer among 719,033 Swedes ages ≥40 years oldwith no prior history of cancer. Study outcomes were any type and site-specific cancer incidence rates on the basis of International Classification of Diseases-10 codes over amedian follow-up of 5 years. To explore the possibility of detection bias and reverse causation, we divided the follow-up time into different time periods (≤12 and >12 months) and estimated risks for each of these intervals. Results In total, 64,319 cases of cancer (affecting 9% of participants) were detected throughout 3,338,226 person-years. The relationship between eGFR and cancer incidence was U shaped. Compared with eGFR of 90-104ml/min, lower eGFR strata associatedwith higher cancer risk (adjusted hazard ratio, 1.08; 95%confidence interval, 1.05 to 1.11 for eGFR<30-59ml/min and adjusted hazard ratio, 1.24; 95%confidence interval, 1.15 to 1.35 for eGFR,30 ml/min). Lower eGFR strata were significantly associated with higher risk of skin, urogenital, prostate, andhematologic cancers.Anycancer risk aswell as skin (nonmelanoma) andurogenital cancer riskswere significantly elevated throughout follow-up time, but they were higher in the first 12 months postregistration. Associationswith hematologic and prostate cancers abrogated after the first 12months of observation, suggesting the presence of detection bias and/or reverse causation. ConclusionsThere is amodestly higher cancer riskinindividualswithmildto severeCKDdriven primarily by skin and urogenital cancers, and this is only partially explained by bias.

Original languageEnglish (US)
Pages (from-to)530-539
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Volume14
Issue number4
DOIs
Publication statusPublished - Apr 5 2019

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ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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