Patients with chronic kidney disease (CKD) are at increased risk for cancer compared with the general population, according to a recent report.
In a study of 13,750 patients with CKD, malignancies developed in 2758 (20.1%) over a follow-up period of 20 years. Following a CKD diagnosis, the median time to cancer development was 8.5 years. The median age at which malignancies developed was 71 years.
Gastrointestinal cancers were the most common malignancies diagnosed followed by prostate cancer and other urinary tract cancers, Ketki K. Tendulkar, MD, of the University of Nebraska Medical Center in Omaha, and colleagues reported in PLoS One. Risk factors for cancer in patients with CKD included increasing age, male sex, and worsening CKD.
“Age appropriate cancer screening should be aggressively pursued in those with progressive CKD,” Dr Tendulkar’s team concluded.
Patients aged 80 years or older had a 3.3-fold greater risk for cancer compared with those younger than 50 years, according to the investigators. Men had a 1.4-fold higher risk compared with women. Compared with patients with an estimated glomerular filtration rate (eGFR, mL/min/1.73 m2) more than 60, those with an eGFR less than 30 also had a 1.4-fold increased risk for cancer. The presence vs absence of diabetes was associated with a 10% lower risk for malignancy.
Among patients diagnosed with CKD when they were younger than 50 years, cancer developed in 14.2% during a median 11 years after the CKD diagnosis. By comparison, among patients diagnosed with CKD when they were aged 50-65 years and 66-80 years, cancer developed in 22.2% at a median of nearly 6.9 years and 1.9 years, respectively, Dr Tendulkar’s team reported.
That 22% figure, the authors noted, “is higher than the reported lifetime risk of cancer in the general population in this age group.”
The study’s retrospective design is its main limitation, the investigators acknowledged. “Another limitation is that it is a single institution study and hence these findings will need to be confirmed in other settings.”
They added, however, that “given the large cohort of patients and the long follow-up duration, these findings appear to be robust.”
The investigators identified patients for their study using the Clinical Research Analytics Environment database, which is funded by the National Institute of General Medical Sciences.
Tendulkar KK, Cope B, Dong J, Plumb TJ, Campbell WS, Ganti AK. Risk of malignancy in patients with chronic kidney disease. PloS One. Published online August 17, 2022. doi:10.1371/journal.pone.0272910