Abstract: SA-PO204
Cancer Risk and Mortality in Patients with CKD: A Population-Based Cohort Study
Session Information
- Onco-Nephrology: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Authors
- Kitchlu, Abhijat, University of Toronto, Toronto, Ontario, Canada
- Reid, Jennifer, ICES, London, Ontario, Canada
- Jeyakumar, Nivethika, ICES, London, Ontario, Canada
- Meraz-Munoz, Alejandro Y., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, COYOACAN, Mexico
- Chan, Christopher T., Toronto General Hospital, Toronto, Ontario, Canada
- Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada
- Kim, Joseph, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Amir, Eitan, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Wald, Ron, St. Michael's Hospital, Toronto, Ontario, Canada
Background
Patients with chronic kidney disease (CKD) may be at increased risk for cancer. CKD may also confer worse cancer outcomes. Existing data is limited and conflicting regarding the associations between kidney function and outcomes in specific malignancies.
Methods
We conducted a population-based cohort study of all Ontario residents 18 years of age or older with available serum creatinine data in the Ontario Laboratory Information System or inclusion in the Canadian Organ Replacement Register as chronic dialysis or kidney transplant patients between April 1, 2007 and October 31, 2016. We categorized patients according to CKD status [estimated glomerular filtration rate (eGFR) >60, 45-59, 30-44, 15-29, <15 mL/min/1.73m2, dialysis and transplant recipients] and assessed overall and site-specific cancer incidence and mortality using multivariable Cox models, accounting for competing risks.
Results
Among 5,871,837 individuals with eGFR data, 29,809 on dialysis and 4,951 kidney transplant recipients there were 325,895 cancer diagnoses over 29,993,847 person-years of follow-up. Relative to patients with eGFR >60 mL/min/1.73m2, total cancer incidence was increased in patients with CKD (stages 3a to 5), adjusted hazard ratios (aHR): 1.07, 95%CI: (1.05, 1.09), 1.04 (1.02, 1.07), 1.01 (0.98, 1.05), 1.13 (1.02, 1.25) on dialysis: 1.31 (1.25, 1.38), and transplant recipients: 1.22 (1.09, 1.36). The risks of bladder, kidney cancer and myeloma were particularly high in patients with CKD. Cancer-specific mortality was increased in CKD (stages 3a to 5), aHRs: 1.21 (1.17, 1.25), 1.30 (1.25, 1.35), 1.45 (1.37, 1.54), 1.41 (1.20, 1.67), dialysis: 1.36 (1.24, 1.49) and transplant: 1.46 (1.16, 1.84). Kidney cancer and myeloma mortality was observed to progressively increase with worsening baseline kidney function. Patients on dialysis had increased risk of mortality related to bladder, kidney cancer and myeloma.
Conclusion
Overall cancer incidence was increased in patients with CKD (stages 3a to 5) and end-stage kidney disease. CKD is associated with increased risks of bladder, kidney cancer and myeloma. Cancer-related mortality is also increased in patients with CKD, on dialysis and post-kidney transplant. Strategies to address the increased burden of cancer in the CKD population are needed.
Funding
- Government Support - Non-U.S.