Patients with chronic kidney disease (CKD) may be at increased risk for cancer as well as dying from it, but the risks vary by CKD stage and cancer type, a new study finds.
Among 5,882,388 Ontario residents, 439,554 had CKD stage 3 to 5, 29,809 received dialysis, and 4951 received a kidney transplant. The 10-year cumulative incidence of any cancer was 9.0%, 15.3%, 13.7%, 11.5%, and 10.8% in patients with an estimated glomerular filtration rate (eGFR) of 60 mL/min/1.73 m2 or higher and CKD stage 3a, 3b, 4, and 5, respectively, and 11.5% and 13.2% in patients receiving dialysis and kidney transplant, respectively. Compared with patients who had normal kidney function, cancer risk was higher in those with CKD stage 3a or kidney transplant, and lower in those with CKD stage 4 or 5, Abhijat Kitchlu, MD, MSc, of the University of Toronto, Toronto, Ontario, Canada, and colleagues reported in the American Journal of Kidney Diseases.
Patients with kidney disease had a particularly high risk for bladder cancer (in CKD stage 3a to 4), kidney cancer, and multiple myeloma. The risk for kidney cancers and multiple myeloma diagnoses increased progressively with worsening kidney function. Patients with kidney disease also had a higher proportion of stage 4 cancers at diagnosis (21% to 31%), which has implications for treatment and survival, the investigators pointed out.
Cancer mortality was higher among patients with kidney disease compared with normal kidney function, particularly death from bladder cancer, kidney cancer, and multiple myeloma, Dr Kitchlu and colleagues reported. Patients with CKD stages 3a, 3b, 4, and kidney transplant recipients had a 27%, 29%, 25%, and 48% increased risk for cancer-specific mortality, respectively. Patients with CKD stage 5 and on dialysis did not have significantly increased risk of cancer-specific mortality.
“Our findings demonstrate a disparity between cancer incidence and cancer-related mortality in patients with kidney disease, suggesting shortcomings in early cancer detection and/or treatment in this population,” Dr Kitchlu’s team stated. The investigators highlighted that improved strategies to detect and treat cancer in patients with kidney disease are needed.
Kitchlu A, Reid J, Jeyakumar N, et al. Cancer risk and mortality in patients with kidney disease: a population-based cohort study. Am J Kidney Dis. Published online April 8, 2022. doi:10.1053/j.ajkd.2022.02.020