title: The risk of cancer in people with diabetes and chronic kidney disease.
abstract: BACKGROUND
  Diabetes and chronic kidney disease (CKD) are both associated with an increased risk of cancer but it is unclear whether diabetes complicated by CKD further augments an individual's cancer risk. The aim of our study was to determine the association of CKD [defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min] with the overall and site-specific risks of incident cancers among individuals with Type 2 diabetes.
  
  
  METHODS
  Cox proportional hazard regression models and competing risk analyses were used to examine the univariate and multivariate adjusted associations between reduced kidney function and the overall and site-specific risks of cancer in participants enrolled in the Action in Diabetes and Vascular disease: Preterax and Diamicron MR controlled evaluation (ADVANCE) trial.
  
  
  RESULTS
  Over a median follow-up of 5.0 years, 700 malignant neoplasms occurred in the 11 140 (6.4%) participants. There was no increase in overall cancer risk [adjusted hazard ratio: 1.07 (95% confidence interval: 0.89-1.29, P = 0.50)] or site-specific cancer risk for individuals with CKD (defined as eGFR < 60 mL/min) compared to those without CKD at baseline. These results were robust to multiple methods and thresholds used to estimate CKD.
  
  
  CONCLUSIONS
  Mild to moderate CKD does not increase the risk of cancer in people with Type 2 diabetes. ADVANCE is registered with ClincalTrial.gov (number NCT00145925).
authors.affiliation: Centre for Kidney Research and Kids Research Institute, The Children’s Hospital at Westmead, Sydney, Australia. germainw@chw.edu.au
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.forename: Sophia
authors.initials: S
authors.lastname: Zoungas
authors.forename: Serigne
authors.initials: S
authors.lastname: Lo
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.forename: Bruce
authors.initials: B
authors.lastname: Neal
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.forename: Vlado
authors.initials: V
authors.lastname: Perkovic
authors.forename: Paul
authors.initials: P
authors.lastname: Glasziou
authors.forename: Bryan
authors.initials: B
authors.lastname: Williams
authors.forename: Kirsten
authors.initials: K
authors.lastname: Howard
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Chapman
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000209:etiology*; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors