Kidney function and cancer risk: an analysis using creatinine and cystatin C in a cohort study

Lees, J. S. et al. (2021) Kidney function and cancer risk: an analysis using creatinine and cystatin C in a cohort study. EClinicalMedicine, 38, 101030. (doi: 10.1016/j.eclinm.2021.101030) (PMID:34505030)

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Abstract

Background: We examined whether an increased risk of cancer incidence and death is associated with kidney function and albuminuria and whether the risk is more readily identified when kidney function is estimated using cystatin C. Methods: Participants were from UK Biobank (recruitment spanning 2007–2010), excluding those with a prior diagnosis of cancer. Estimated glomerular filtration rate (ml/min/1.73m2) was calculated using creatinine (eGFRcr), cystatin C (eGFRcys) and creatinine-cystatin C (eGFRcr-cys). Cox proportional hazards models tested associations between eGFR, urinary albumin:creatinine ratio (uACR) and cancer incidence and death. Findings: In 431,263 participants over median follow-up of 11.3 (IQR 10.6–12.0) years, there were 41,745 incident cancers and 11,764 cancer deaths. eGFRcys was most strongly associated with cancer incidence and death (HR 1.04 (95% CI 1.03–1.04) and 1.06 (1.05–1.07) per 10 ml/min/1.73m2 decline, respectively). eGFRcr was not associated with either outcome (incidence: HR 1.00 (1.00–1.01); death: HR 0.99 (0.98–1.01) per 10 ml/min/1.73m2 decline). Relative to eGFRcys>90 or uACR<3 mg/mmol, eGFRcys60–89 (HR 1.04 (95% CI 1.02–1.07)), eGFRcys<60 (HR 1.19 (1.14–1.24)) and uACR≥3 mg/mmol (HR 1.09 (1.06–1.12)) were associated with higher risk of incident cancer. eGFRcys60–89 (HR 1.15 (1.10–1.21)); eGFRcys<60 (HR 1.48 (1.38–1.59)) and uACR≥3 mg/mmol (HR 1.17 (1.11–1.24)) were associated with cancer death. Interpretation: Excess risk of cancer incidence and cancer death is more readily captured in early chronic kidney disease by eGFRcys than by current measures. The association between kidney function, uACR and cancer death in particular is concerning and warrants further scrutiny.

Item Type:Articles
Additional Information:This research was also supported by the Office of the Chief Scientific Adviser (CSO), ref PCL/20/10.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Ho, Dr Frederick and Sullivan, Dr Michael and Lees, Jennifer and Jani, Dr Bhautesh and Welsh, Dr Paul and Celis, Dr Carlos and Pell, Professor Jill and Sattar, Professor Naveed and Parra Soto, Solange Liliana and Mark, Professor Patrick and Lang, Dr Ninian
Authors: Lees, J. S., Ho, F., Parra -Soto, S., Celis-Morales, C., Welsh, P., Sullivan, M. K., Jani, B. D., Sattar, N., Lang, N. N., Pell, J. P., Webster, A. C., and Mark, P. B.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
Journal Name:EClinicalMedicine
Publisher:Lancet Publishing Group
ISSN:2589-5370
ISSN (Online):2589-5370
Published Online:26 July 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in EClinicalMedicine 38: 101030
Publisher Policy:Reproduced under a Creative Commons License
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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science