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Title: Chronic kidney disease and the risk of cancer: An individual patient data meta-analysis of 32,057 participants from six prospective studies
Authors: Wong, G
Staplin, N
Emberson, J
Baigent, C
Turner, R
Chalmers, J
Zoungas, S
Pollock, C
Cooper, B
Harris, D
Wang, J.J 
Mitchell, P
Prince, R
Lim, W.H
Lewis, J
Chapman, J
Craig, J
Keywords: adult
cancer growth
cancer incidence
cancer mortality
cancer risk
chronic kidney disease
digestive system cancer
endocrine tumor
follow up
glomerulus filtration rate
hemodialysis patient
major clinical study
malignant neoplastic disease
prostate cancer
risk reduction
urinary tract cancer
chronic kidney failure
meta analysis
middle aged
risk factor
Middle Aged
Renal Insufficiency, Chronic
Risk Factors
Issue Date: 2016
Citation: Wong, G, Staplin, N, Emberson, J, Baigent, C, Turner, R, Chalmers, J, Zoungas, S, Pollock, C, Cooper, B, Harris, D, Wang, J.J, Mitchell, P, Prince, R, Lim, W.H, Lewis, J, Chapman, J, Craig, J (2016). Chronic kidney disease and the risk of cancer: An individual patient data meta-analysis of 32,057 participants from six prospective studies. BMC Cancer 16 (1) : 488. ScholarBank@NUS Repository.
Rights: Attribution 4.0 International
Abstract: Background: Chronic kidney disease (CKD) is an established risk factor for cardiovascular disease but the relevance of reduced kidney function to cancer risk is uncertain. Methods: Individual patient data were collected from six studies (32,057 participants); including one population-based cohort and five randomized controlled trials. Participants were grouped into one of five CKD categories (estimated glomerular filtration rate [eGFR] ≥75 mL/min/1.73 m2; eGFR ≥60 to <75 mL/min/1.73 m2; eGFR ≥45 to <60 mL/min/1.73 m2; eGFR <45 mL/min/1.73 m2; on dialysis). Stratified Cox regression was used to assess the impact of CKD category on cancer incidence and cancer death. Results: Over a follow-up period of 170,000 person-years (mean follow-up among survivors 5.6 years), 2626 participants developed cancer and 1095 participants died from cancer. Overall, there was no significant association between CKD category and cancer incidence or death. As compared with the reference group with eGFR ≥75 mL/min/1.73 m2, adjusted hazard ratio (HR) estimates for each category of renal function, in descending order, were: 0.98 (95 % CI 0.87-1.10), 0.99 (0.88-1.13), 1.01 (0.84-1.22) and 1.24 (0.97-1.58) for cancer incidence, and 1.03 (95 % CI 0.86-1.24), 0.95 (0.78-1.16), 1.00 (0.76-1.33), and 1.58 (1.09-2.30) for cancer mortality. Among dialysis patients, there was an excess risk of cancers of the urinary tract (adjusted HR: 2.34; 95 % CI 1.10-4.98) and endocrine cancers (11.65; 95 % CI: 1.30-104.12), and an excess risk of death from digestive tract cancers (2.11; 95 % CI: 1.13-3.99), but a reduced risk of prostate cancers (0.38; 95 % CI: 0.18-0.83). Conclusions: Whilst no association between reduced renal function and the overall risk of cancer was observed, there was evidence among dialysis patients that the risk of cancer was increased (urinary tract, endocrine and digestive tract) or decreased (prostate) at specific sites. Larger studies are needed to characterise these site-specific associations and to identify their pathogenesis. © 2016 The Author(s).
Source Title: BMC Cancer
ISSN: 14712407
DOI: 10.1186/s12885-016-2532-6
Rights: Attribution 4.0 International
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