Estimated glomerular filtration rate and the risk of cancer

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.