title: Chronic Kidney Disease is Associated With Upper Tract Urothelial Carcinoma: A Nationwide Population-Based Cohort Study in Taiwan.
abstract: Increased urinary tract malignancy has been reported in end-stage renal disease (ESRD). However, little is known about chronic kidney disease (CKD). This study is designed to explore the association between CKD and upper tract urothelial carcinoma (UTUC).Using Taiwan's Longitudinal Health Insurance Database, we studied CKD patients between January 2000 and December 2011. The non-CKD controls were selected at a ratio of 4:1 and frequency matched by gender, age group, and index date. We used the chi-square test and t test to analyze the sociodemographic information and comorbidities. Cox regression analysis was used to calculate the hazard ratio (HR) and 95% confidence interval (CI).The selected cases included 45,321 CKD cases and 181,284 controls. A significantly higher incidence of UTUC was noted in the CKD group (0.22% vs 0.07%, P < 0.001). In univariate analysis, CKD, female gender, age, hypertension, hematuria, repeated urinary tract infection, bladder cancer, and ESRD were all associated with UTUC. In multivariate analysis, only CKD, female gender, age, hematuria, bladder cancer, and ESRD were significantly associated. The HR for CKD was 1.63 (95% CI: 1.26-2.13). Females had a higher HR of 1.38 (95% CI: 1.11-1.71). After excluding those patients who progressed to dialysis or kidney transplantation, the risk for CKD was still high, with an HR of 1.72 (95% CI: 1.33-2.33).CKD is a significant factor associated with UTUC. We should pay attention to the possibility of UTUC for CKD patients before they progress to ESRD.
authors.affiliation: From the Department of Urology (J-SC), Sinying Hospital, Ministry of Health and Welfare, Sinying; Department of Urology (J-SC, C-HS); Department of Medical Research (C-LL, SC-CC); Department of Psychiatric (L-CH), Ditmanson Chiayi Christian Hospital, Chiayi; Department of Public Health (C-LL), Medical College, National Cheng-Kung University, Tainan; and Department of Pediatrics (SC-CC), School of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Jeng-Sheng
authors.initials: JS
authors.lastname: Chen
authors.forename: Chin-Li
authors.initials: CL
authors.lastname: Lu
authors.forename: Li-Chung
authors.initials: LC
authors.lastname: Huang
authors.forename: Cheng-Huang
authors.initials: CH
authors.lastname: Shen
authors.forename: Solomon Chih-Cheng
authors.initials: SC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D013624:Taiwan; D014516:Ureteral Neoplasms / Q000150:complications* / Q000453:epidemiology; D055815:Young Adult