Patients with cancer have a higher risk for kidney failure requiring replacement therapy (KFRT), and that risk differs by cancer type, a new study finds.
Using the Korean National Health Insurance Service database, investigators examined KFRT risk among 824,365 Korean patients with cancer compared with 1,648,730 patients without cancer matched by age, sex, estimated glomerular filtration rate (eGFR), diabetes status, and hypertension status.
KFRT was required for 1.07 patients with cancer compared with 0.51 patients without cancer per 1000 person-years, Soo Wan Kim, MD, PhD, Chonnam National University Medical School, Korea, and colleagues reported in the American Journal of Kidney Diseases. Cancer was significantly associated with a 2.3-fold increased risk for KFRT, in a fully adjusted model. Among patients with chronic kidney disease (CKD), those with vs without cancer had a significant 1.4-fold increased risk for KFRT. Among patients with proteinuria, cancer was associated with a significant 1.3-fold increased risk for KFRT.
“The presence of kidney failure has significant influence on the treatment options available to patients with cancer, including certain chemotherapeutic agents, hematopoietic stem cell transplant, and surgery, and affects overall cancer-related survival,” Dr Kim’s team wrote. “Therefore, it is crucial for nephrologists and oncologists to be aware of the risk of KFRT in patients with cancer so better preventive strategies can be developed.”
Across 23 types of cancer, KFRT risk was higher among patients with hematologic malignancies than for patients with solid cancers. Multiple myeloma was significantly associated with a 19-fold increased risk for KFRT compared with no cancer (29.1 cases per 1000 person-years). Among the solid cancers, kidney, liver, ovary, cervix, bladder, uterus, and esophagus cancer were associated with a 4.9-, 3.9-, 3.9-, 3.9-, 3.3-, 2.9, and 2.1-fold higher risk of KFRT, respectively, compared with no cancer. Dr Kim’s team observed that “patients with these cancers require greater kidney failure prevention efforts and closer surveillance.”
No greater risk for KFRT was observed with cancers of the pancreas, lung, skin, oral cavity, larynx, and nerves.
The investigators adjusted models for age, sex, smoking, alcohol, exercise, low income, body mass index, proteinuria, diabetes, hypertension, dyslipidemia, ischemic heart disease, stroke, peripheral artery disease, and CKD.
Nephrotoxicity from anticancer therapy, electrolyte/metabolic disturbances, contrast medium-associated acute kidney injury, nephrectomy, and obstructive nephropathy due to cancer invasion or lymphadenopathy are some well-known the risk factors for kidney injury in patients with cancer, the investigators noted.
Kim CS, Kim B, Suh SH, et al. Risk of kidney failure in patients with cancer: a South Korean population-based cohort study. Am J Kidney Dis. 79(4):507-517. doi:10.1053/j.ajkd.2021.06.024