Chronic kidney disease and incident cancer risk: an individual participant data meta-analysis.
Mok Y., Surapaneni A., Sang Y., Coresh J., Grams ME., Matsushita K., Ballew SH., Alencar de Pinho N., Ärnlöv J., Barreto SM., Bell S., Brenner H., Carrero J-J., Chinnadurai R., Ciemins E., Gansevoort RT., Jassal SK., Jung KJ., Kirchner HL., Konta T., Kovesdy CP., Luo L., Pandit K., Rahman M., Robinson-Cohen C., Sabanayagam C., Schultheiss UT., Shlipak M., Staplin N., Tonelli M., Wang AY-M., Wen C-P., Woodward M., Lees JS., CKD Prognosis Consortium .
BACKGROUND: Studies examining the association of chronic kidney disease (CKD) with cancer risk have demonstrated conflicting results. METHODS: This was an individual participant data meta-analysis including 54 international cohorts contributing to the CKD Prognosis Consortium. Included cohorts had data on albuminuria [urine albumin-to-creatinine ratio (ACR)], estimated glomerular filtration rate (eGFR), overall and site-specific cancer incidence, and established risk factors for cancer. Included participants were aged 18 years or older, without previous cancer or kidney failure. RESULTS: Among 1,319,308 individuals, the incidence rate of overall cancer was 17.3 per 1000 person-years. Higher ACR was positively associated with cancer risk [adjusted hazard ratio 1.08 (95% CI 1.06-1.10) per 8-fold increase in ACR]. No association of eGFR with overall cancer risk was seen. For site-specific cancers, lower eGFR was associated with urological cancer and multiple myeloma, whereas higher ACR was associated with many cancer types (kidney, head/neck, colorectal, liver, pancreas, bile duct, stomach, larynx, lung, hemolymphatic, leukaemia, and multiple myeloma). Results were similar in a 1-year landmark analysis. DISCUSSION: Albuminuria, but not necessarily eGFR, was independently associated with the subsequent risk of cancer. Our results warrant an investigation into mechanisms that explain the link between albuminuria and cancer.