title: High cumulative incidence of cancer in patients with cardio-renal-anaemia syndrome.
abstract: OBJECTIVE
  The combination of chronic kidney disease (CKD), chronic heart failure (HF), and anaemia, the so-called cardio-renal-anaemia syndrome (CRA) is associated with dysregulation of erythropoietin levels and inflammation. Both have been associated with the development of cancer. This study aimed to determine the cumulative incidence of cancer in patients with CRA, as compared with anaemic CKD and control patients.
  
  
  RESULTS
  Patients aged <80 years who attended the nephrology or cardiology outpatient clinics between March 2006 and November 2007 were eligible for inclusion in this retrospective case-control study if haemoglobin <8.1 mmol/L (13 g/dL) and serum creatinine >80 mmol/L (0.90 mg/dL). Medical records dating back to 1996 were reviewed. The relationship between cancer and CRA, chronic HF, CKD, and anaemia was analysed using logistic regression analysis. Data from 1087 patients were reviewed. We identified 348 patients with both CKD and anaemia, of whom 132(38.3%) had CRA. The control group included 264 patients attending the hypertension outpatient clinic. Patients with CRA had a 19% cumulative incidence of cancer compared with 11% for patients with anaemia, CKD and no chronic HF, and 11% in the control group. The odds ratio (OR) for cancer was 1.8(95% CI 1.0-3.2) for the CRA group compared with the control group. Chronic HF was an independent risk factor for cancer after correction for age and gender (adjusted OR 2.0; 95% CI 1.2-3.3, P = 0.007).
  
  
  CONCLUSIONS
  The cumulative incidence of cancer among patients with CRA is high compared with controls and to anaemic CKD patients without chronic HF. Chronic HF was an independent risk factor for cancer. These results stress the importance of clarifying the mechanisms involved in the development of cancer in CRA.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Nicolas F
authors.initials: NF
authors.lastname: Schroten
authors.forename: Karien
authors.initials: K
authors.lastname: van der Putten
authors.forename: Frans H
authors.initials: FH
authors.lastname: Rutten
authors.forename: Adry
authors.initials: A
authors.lastname: Diepenbroek
authors.forename: Arend
authors.initials: A
authors.lastname: Mosterd
authors.forename: Carlo A J M
authors.initials: CA
authors.lastname: Gaillard
mesh_terms: D000368:Aged; D000740:Anemia / Q000150:complications* / Q000503:physiopathology; D016022:Case-Control Studies; D016001:Confidence Intervals; D004921:Erythropoietin; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D017467:Receptors, Erythropoietin / Q000096:biosynthesis; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome
chemical_list: D017467:Receptors, Erythropoietin; D004921:Erythropoietin