title: Reduced estimated GFR and cancer mortality.
abstract: BACKGROUND
  Chronic kidney disease is associated with an increased risk of cancer, but whether reduced kidney function also leads to increased cancer mortality is uncertain. The aim of our study was to assess the independent effects of reduced kidney function on the risk of cancer deaths.
  
  
  METHODS
  Prospective population-based cohort study.
  
  
  METHODS
  Participants of the Blue Mountains Eye Study (n=4,077; aged 49-97 years).
  
  
  METHODS
  Estimated glomerular filtration rate (eGFR).
  
  
  RESULTS
  Overall and site-specific cancer mortality.
  
  
  RESULTS
  During a median follow-up of 12.8 (IQR, 8.6-15.8) years, 370 cancer deaths were observed in our study cohort. For every 10-mL/min/1.73 m(2) reduction in eGFR, there was an increase in cancer-specific mortality of 18% in the fully adjusted model (P<0.001). Compared with participants with eGFR ≥ 60 mL/min/1.73 m(2), the adjusted HR for cancer-specific mortality for those with eGFR<60 mL/min/1.73 m(2) was 1.27 (95% CI, 1.00-1.60; P=0.05). This excess cancer mortality varied with site, with the greatest risk for breast and urinary tract cancer deaths (adjusted HRs of 1.99 [95% CI, 1.05-3.85; P=0.01] and 2.54 [95% CI, 1.02-6.44; P=0.04], respectively).
  
  
  CONCLUSIONS
  Residual confounding, such as from unmeasured socioeconomic factors and the potential effects of erythropoiesis-stimulating agents on cancer deaths, may have occurred.
  
  
  CONCLUSIONS
  eGFR<60 mL/min/1.73m(2) appears to be a significant risk factor for death from cancer. These effects appear to be site specific, with breast and urinary tract cancers incurring the greatest risk of death among those with reduced kidney function.
authors.affiliation: Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, New South Wales, Australia; Institute for Social- and Preventive Medicine, University Bern, Bern, Switzerland.
authors.forename: Samuel
authors.initials: S
authors.lastname: Iff
authors.affiliation: Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, New South Wales, Australia; School of Public Health, University of Sydney, New South Wales, Australia.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.affiliation: School of Public Health, University of Sydney, New South Wales, Australia.
authors.forename: Robin
authors.initials: R
authors.lastname: Turner
authors.affiliation: Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia.
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Chapman
authors.affiliation: Centre for Vision Research, Westmead Millennium Institute, Westmead Hospital, New South Wales, Australia.
authors.forename: Jie J
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Centre for Vision Research, Westmead Millennium Institute, Westmead Hospital, New South Wales, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.affiliation: Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, New South Wales, Australia; School of Public Health, University of Sydney, New South Wales, Australia; Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia. Electronic address: germainw@chw.edu.au.
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000150:complications / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D051437:Renal Insufficiency / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014571:Urologic Neoplasms / Q000150:complications / Q000401:mortality*
keywords: Cancer; chronic kidney disease; estimated glomerular filtration rate; mortality; survival analyses