The risks for death and hospitalization are higher among patients with nondialysis-dependent chronic kidney disease (CKD) than among patients with nonmetastatic solid cancers, a new Canadian study finds.

Using a population-based database from Alberta, Canada, investigators identified 51,159 adults with advanced CKD who did not receive dialysis or kidney transplantation (estimated glomerular filtration rate less than 30 mL/min/1.73 m2 or albumin-to-creatinine ratio exceeding 220 mg/mmol or protein-to-creatinine ratio exceeding 350 mg/mmol). The comparator groups were diagnosed with 1 of the 10 leading solid cancers, including tumors of the prostate, bladder, kidney, lung, breast, colon or rectum, thyroid, uterus, pancreas, or mouth. A total of 115,504 patients had nonmetastatic cancer and 33,831 had metastatic cancer.

As expected, mortality, hospitalization, and long-term care rates were highest for patients with metastatic cancer. CKD, however, was associated with worse outcomes compared with nonmetastatic cancer over 5 years, corresponding author Marcello Tonelli, MD, SM, MSc, of the University of Calgary in Alberta, and colleagues reported in JAMA Network Open.

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The 1-year survival rate was 83.3% with CKD, 91.2% with nonmetastatic cancer, and 52.8% with metastatic cancer. Within 5 years, survival had declined to 54.6% with CKD, 76.6% with nonmetastatic cancer, and 33.9% with metastatic cancer.

Death risk at 1 year was comparable between the CKD and nonmetastatic cancer cohorts, but at years 1 to 5 it was a significant 23% higher with CKD, the investigators reported. The top cause of death was cardiovascular disease in the CKD cohort and neoplasm in the cancer cohorts.

From years 1 to 5, the adjusted relative rate of hospitalization, length of hospital stay, and long-term care placement were a significant 55%, 65%, and 36% higher, respectively, among patients with CKD than for those with nonmetastatic cancer, Dr Tonelli and colleagues reported. The investigators adjusted all analyses for sex, age, and comorbidities.

“Overall, our findings indicate that the clinical need of patients with CKD is substantial and, arguably, similar to that of patients with cancer,” Dr Tonelli’s team stated. “The data presented here may be useful for advocacy efforts that seek to raise awareness about the public health importance of CKD. If such advocacy can be used to strengthen investment in the kidney research agenda, perhaps this would facilitate more rapid progress toward better outcomes for patients with CKD, including better management of CKD-associated comorbidity.”


Tonelli M, Lloyd A, Cheung WY, et al. Mortality and resource use among individuals with chronic kidney disease or cancer in Alberta, Canada, 2004-2015. JAMA Netw Open. Published online January 26, 2022. doi:10.1001/jamanetworkopen.2021.44713