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Health See other Health Articles Title: Impaired Kidney Function Linked to Higher Renal Cancer Risk Impaired kidney function, as measured by depressed glomerular filtration rates (GFR), is associated with a significantly higher risk of being diagnosed with renal and urothelial cancers, according to a retrospective cohort study. William T. Lowrance, MD, MPH, from the Huntsman Cancer Institute, University of Utah, Division of Urology, Salt Lake City, and colleagues report the findings of their study, powered by Kaiser Permanente Northern California records for 1.19 million adult patients with no history of cancer and known kidney function, in an article published online May 29 in the Journal of the American Society of Nephrology. The number of patients diagnosed with chronic kidney disease (CKD) is rising, Dr. Lowrance and coauthors note, with an estimated 11.5% of US residents registering diminished estimated GFR (eGFR) levels. To determine whether the level of kidney function was associated with a higher risk for subsequent cancer, the research team analyzed data from the regional cancer registry, looking for heightened risk for a wide variety of cancers. The patients were more likely to be older, people of color, poorer, and current or former smokers. The researchers identified 76,809 incident cancers during the 5-plus years of follow-up, with the strongest correlations found between reduced kidney function and increased risk for renal and urothelial cancers. The researchers adjusted for confounders including age, gender, race, socioeconomic status, comorbidities, proteinuria, hematuria, and body mass index. When eGFR rates ranged between 45 and 59 mL/minute/1.73 m2, incident diagnosed renal cancer rate increased by 1.39 (95% confidence interval [CI], 1.22 - 1.58). That hazard ratio inched up to 1.81 (95% CI, 1.51 - 2.17) for eGFR ranging from 30 to 44 mL/minute/1.73 m2. And when eGFR dropped to less than 30 mL/minute/1.73 m2, risk for renal cancer rate soared to 2.28 (95% CI, 1.78 - 2.92), and there also was a 48% increased rate of urothelial cancer. The authors found no similarly heightened risk for breast, colorectal, lung, or prostate cancer. "Our findings reveal the association of CKD and cancer risk is site-specific for renal and urothelial cancers, and does not appear to be associated with an individual's overall cancer risk," the authors write. Although the study team asserts that their findings could more effectively target cancer screening recommendations for patients with CKD, an accompanying editorial says the cancer associations are "smaller than that generally considered acceptable for screening purposes." In the editorial, Jonathan N. Hofmann, PhD, MPH, and Mark P. Purdue, PhD, from the Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, point to a promising area for continued research: whether racial differences help account for the increased incidence rate of renal cell carcinoma seen among blacks. "The prevalence of CKD is higher, and impairment of renal function is likely to be more severe among African Americans than among non-Hispanic whites," the editorialists write. "[W]e found that lower GFR level was an independent risk factor for incident renal and urothelial cancer, but not for prostate, colorectal, lung, breast, or all cancers combined," Dr. Lowrance and colleagues conclude. "If GFR is associated with an increased risk of renal and urothelial cancer, then it could have implications for directing cancer screening efforts in select populations." Financial support for the study was provided by the National Institutes of Health, the Huntsman Cancer Institute, and the National Institute of Diabetes, Digestive and Kidney Diseases. The authors have disclosed no relevant financial relationships. Dr. Hofmann and Dr. Purdue have disclosed receiving financial support from the National Institutes of Health. J Am Soc Nephrol. Published online May 29, 2014. Abstract Post Comment Private Reply Ignore Thread
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