Cancer-Specific Mortality in Chronic Kidney Disease

Weng, Pei-Hsuan; Hung, Kuan‐Yu; Huang, Hsien‐Liang; Chen, Jen‐Hau; Sung, Pei-Kun; Huang, Kuo‐Chin

doi:10.2215/cjn.09011010

Cited by 143 publications

(121 citation statements)

References 34 publications

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“…7,19 However, details about malignancy-related deaths are sparse, and a recent report from Taiwan indicated that patients with CKD had a higher mortality risk from liver, kidney, and urinary tract cancer. 20 Our results also highlight the leading causes of malignancy-related deaths (Supplemental Table 3) among the CKD population followed in our healthcare system. Overall, these higher numbers of cancer-related deaths could be attributed to the fact that a large proportion of patients receiving care for cancer at our healthcare system had underlying CKD or develop CKD during the treatment course.…”

Section: Discussionsupporting

confidence: 60%

Cause-Specific Deaths in Non–Dialysis-Dependent CKD

Navaneethan

Schold

Arrigain

et al. 2015

Journal of the American Society of Nephrology

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CKD is associated with higher risk of death, but details regarding differences in cause-specific death in CKD are unclear. We examined the leading causes of death among a non-dialysis-dependent CKD population using an electronic medical record-based CKD registry in a large healthcare system and the Ohio Department of Health mortality files. We included 33,478 white and 5042 black patients with CKD who resided in Ohio between January 2005 and September 2009 and had two measurements of eGFR,60 ml/min per 1.73 m 2 obtained 90 days apart. Causes of death (before ESRD) were classified into cardiovascular, malignancy, and non-cardiovascular/non-malignancy diseases and non-disease-related causes. During a median follow-up of 2.3 years, 6661 of 38,520 patients (17%) with CKD died. Cardiovascular diseases (34.7%) and malignant neoplasms (31.8%) were the leading causes of death, with malignancy-related deaths more common among those with earlier stages of kidney disease. After adjusting for covariates, each 5 ml/min per 1.73 m 2 decline in eGFR was associated with higher risk of death due to cardiovascular disease (hazard ratio [HR], 1.10; 95% confidence interval [95% CI], 1.08 to 1.12) and non-cardiovascular/ non-malignancy diseases (HR, 1.12; 95% CI, 1.09 to 1.14) but not to malignancy. In the adjusted models, blacks had overall-mortality hazard ratios similar to those of whites but higher hazard ratios for cardiovascular deaths. Further studies to confirm these findings and explain the mechanisms for differences are warranted. In addition to lowering cardiovascular burden in CKD, efforts to target known risk factors for cancer at the population level are needed.

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Section: Discussionsupporting

confidence: 60%

Cause-Specific Deaths in Non–Dialysis-Dependent CKD

Navaneethan

Schold

Arrigain

et al. 2015

Journal of the American Society of Nephrology

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“…13 A separate study has also observed increased renal and urothelial cancer-specific mortality among patients with CKD. 16 Among a much larger, diverse population-based sample, we did not find GFR to be an independent predictor of overall cancer risk or specific cancers, such as prostate, breast, lung, or colorectal, after rigorously adjusting for potential confounders and excluding any incident cancers diagnosed within the first 2 years of followup and all GFR measurements within 3 months before a cancer diagnosis. Our findings reveal that the association of CKD and cancer risk is site-specific for renal and urothelial cancers and does not seem to be associated with an individual's overall cancer risk.…”

Section: Discussionmentioning

confidence: 58%

CKD and the Risk of Incident Cancer

Lowrance

Ordoñez

Udaltsova

et al. 2014

Journal of the American Society of Nephrology

230

183

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Previous studies report a higher risk of cancer in patients with ESRD, but the impact of less severe CKD on risk of cancer is uncertain. Our objective was to evaluate the association between level of kidney function and subsequent cancer risk. We performed a retrospective cohort study of 1,190,538 adults who were receiving care within a health care delivery system, had a measurement of kidney function obtained between 2000 and 2008, and had no prior cancer. We examined the association between level of eGFR and the risk of incident cancer; the primary outcome was renal cancer, and secondary outcomes were any cancer and specific cancers (urothelial, prostate, breast, lung, and colorectal). During 6,000,420 person-years of follow-up, we identified 76,809 incident cancers in 72,875 subjects. After adjustment for time-updated confounders, lower eGFR (in milliliters per minute per 1.73 m 2 ) was associated with an increased risk of renal cancer (adjusted hazard ratio [HR], 1.39; 95% confidence interval [95% CI], 1.22 to 1.58 for eGFR=45-59; HR, 1.81; 95% CI, 1.51 to 2.17 for eGFR=30-44; HR, 2.28; 95% CI, 1.78 to 2.92 for eGFR,30). We also observed an increased risk of urothelial cancer at eGFR,30 but no significant associations between eGFR and prostate, breast, lung, colorectal, or any cancer overall. In conclusion, reduced eGFR is associated with an independently higher risk of renal and urothelial cancer but not other cancer types.

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“…We did not collect data specific for the type of cancers in our study and until further analysis is done we cannot establish a causal link between CKD and cancer risk. In any case, CKD was associated with increased cancer-specific mortality than general population 20 and interventions to reduce the risk of cancer and improve the outlook for those who develop cancer are needed.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of various comorbidities among veterans with chronic kidney disease and its comparison with other datasets

Patel

Golzy

Nainani³

et al. 2015

Renal Failure

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Chronic kidney disease (CKD) has a complicated interrelationship with various comorbidities. The purpose of this study was to describe the prevalence of various comorbidities among veterans with CKD and compare it with other datasets like Kidney Early Evaluation Program (KEEP), National Health and Nutrition Examination Survey (NHANES) and Medicare. Patients who had at least one outpatient visit in year 2007 (1 January 2007 to 31 December 2007) were included in the study (n ¼ 75,787). Glomerular filtration rate (eGFR) was estimated by the Modification of Diet in Renal Disease (MDRD) study equation. CKD prevalence was calculated based on one or two serum creatinine values at least 3 months apart. Demographic data were obtained including age, gender, race, weight, height and body mass index (BMI). The prevalence of various comorbidities was also collected based on ICD 9 codes from the problem list. The prevalence of CKD among veterans was 47.3%, much higher than estimated in the US population. Patients with CKD were more likely to have any vascular disease (36.89% vs. 14.87%), diabetes (34.18% vs. 17.83%), hypertension (86.65% vs. 57.56%), and cancer (18.69% vs. 9.23%). Irrespective of age, the prevalence of vascular disease was much higher among veterans with CKD. The prevalence of coronary artery disease, peripheral vascular disease, and cancer was much higher among elderly veterans with CKD as compared to other datasets. CKD is a growing endemic associated with a high frequency of concomitant chronic illnesses. Public health resources should be applied for early recognition and risk modification of CKD. ARTICLE HISTORY

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Cancer-Specific Mortality in Chronic Kidney Disease

Cited by 143 publications

References 34 publications

Cause-Specific Deaths in Non–Dialysis-Dependent CKD

Cause-Specific Deaths in Non–Dialysis-Dependent CKD

CKD and the Risk of Incident Cancer

Prevalence of various comorbidities among veterans with chronic kidney disease and its comparison with other datasets

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