The ‘other’ big complication: how chronic kidney disease impacts on cancer risks and outcomes

Lees, J. S. , Elyan, B. M.P., Hermann, S. M., Lang, N. N. , Jones, R. J. and Mark, P. B. (2023) The ‘other’ big complication: how chronic kidney disease impacts on cancer risks and outcomes. Nephrology Dialysis Transplantation, 38(5), pp. 1071-1079. (doi: 10.1093/ndt/gfac011) (PMID:35090037) (PMCID:PMC10157781)

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Cancer is the second leading cause of death in people with chronic kidney disease (CKD) after cardiovascular disease. The incidence of CKD in patients with cancer is higher than in the non-cancer population. Across various populations, CKD is associated with an elevated risk of cancer incidence and cancer death compared to people without CKD, though the risks are cancer site-specific. Higher risk of cancer is detectable in mild CKD (estimated glomerular filtration rate [eGFR] 60–89 ml/min/1.73 m2) although this risk is more obvious if sensitive markers of kidney disease are used, such as cystatin C. Independent of eGFR, albuminuria is associated with increased risk of site-specific cancer incidence and death. Here, we explore the potential mechanisms for the increased risk of cancer observed in CKD, including patient factors (shared risks such as cardiometabolic disease, obesity, smoking, diet, lifestyle and environment), disease (genetic, inflammatory and infective) and treatment factors. In particular, we discuss the ways in which renal adverse events associated with conventional chemotherapies and newer systemic anti-cancer therapies (including targeted and immunotherapies) may contribute to worse cancer outcomes in people with CKD. Finally, we review the potential benefits of acknowledging increased risk of cancer in risk prediction tools used for management of CKD.

Item Type:Articles
Additional Information:J.S.L. is funded by a Chief Scientist Office (Scotland) Postdoctoral Lectureship (PCL/20/10). S.M.H is supported by NIH grant K08 DK118120 and Mayo Clinic K2R award.
Glasgow Author(s) Enlighten ID:Lang, Professor Ninian and Mark, Professor Patrick and Lees, Jennifer and Jones, Professor Robert
Authors: Lees, J. S., Elyan, B. M.P., Hermann, S. M., Lang, N. N., Jones, R. J., and Mark, P. B.
College/School:College of Medical Veterinary and Life Sciences > School of Cancer Sciences
College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Nephrology Dialysis Transplantation
Publisher:Oxford University Press
ISSN (Online):1460-2385
Published Online:28 January 2022
Copyright Holders:Copyright © The Author(s) 2022
First Published:First published in Nephrology Dialysis Transplantation 38(5):1071-1079
Publisher Policy:Reproduced under a Creative Commons licence

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