title: Chronic kidney disease and the risk of cancer: an individual patient data meta-analysis of 32,057 participants from six prospective studies.
abstract: Chronic kidney disease (CKD) is an established risk factor for cardiovascular disease but the relevance of reduced kidney function to cancer risk is uncertain.
  
  
  
  Individual patient data were collected from six studies (32,057 participants); including one population-based cohort and five randomized controlled trials. Participants were grouped into one of five CKD categories (estimated glomerular filtration rate [eGFR] ≥75 mL/min/1.73 m(2); eGFR ≥60 to <75 mL/min/1.73 m(2); eGFR ≥45 to <60 mL/min/1.73 m(2); eGFR <45 mL/min/1.73 m(2); on dialysis). Stratified Cox regression was used to assess the impact of CKD category on cancer incidence and cancer death.
  
  
  
  Over a follow-up period of 170,000 person-years (mean follow-up among survivors 5.6 years), 2626 participants developed cancer and 1095 participants died from cancer. Overall, there was no significant association between CKD category and cancer incidence or death. As compared with the reference group with eGFR ≥75 mL/min/1.73 m(2), adjusted hazard ratio (HR) estimates for each category of renal function, in descending order, were: 0.98 (95 % CI 0.87-1.10), 0.99 (0.88-1.13), 1.01 (0.84-1.22) and 1.24 (0.97-1.58) for cancer incidence, and 1.03 (95 % CI 0.86-1.24), 0.95 (0.78-1.16), 1.00 (0.76-1.33), and 1.58 (1.09-2.30) for cancer mortality. Among dialysis patients, there was an excess risk of cancers of the urinary tract (adjusted HR: 2.34; 95 % CI 1.10-4.98) and endocrine cancers (11.65; 95 % CI: 1.30-104.12), and an excess risk of death from digestive tract cancers (2.11; 95 % CI: 1.13-3.99), but a reduced risk of prostate cancers (0.38; 95 % CI: 0.18-0.83).
  
  
  
  Whilst no association between reduced renal function and the overall risk of cancer was observed, there was evidence among dialysis patients that the risk of cancer was increased (urinary tract, endocrine and digestive tract) or decreased (prostate) at specific sites. Larger studies are needed to characterise these site-specific associations and to identify their pathogenesis.
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, Australia. Germaine.wong@health.nsw.gov.au.|Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia. Germaine.wong@health.nsw.gov.au.
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Oxford, UK.
authors.forename: Natalie
authors.initials: N
authors.lastname: Staplin
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Oxford, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Emberson
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Oxford, UK.|Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, Oxford, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Baigent
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
authors.forename: Robin
authors.initials: R
authors.lastname: Turner
authors.affiliation: The George Institute for Global Health, Sydney, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.affiliation: The George Institute for Global Health, Sydney, Australia.|Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, VIC, Australia.
authors.forename: Sophia
authors.initials: S
authors.lastname: Zoungas
authors.affiliation: Northern Clinical School, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia.
authors.forename: Carol
authors.initials: C
authors.lastname: Pollock
authors.affiliation: Northern Clinical School, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia.
authors.forename: Bruce
authors.initials: B
authors.lastname: Cooper
authors.affiliation: Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Harris
authors.affiliation: Centre for Vision Research, Westmead Millennium Institute of Medical Research, University of Sydney, Sydney, Australia.
authors.forename: Jie Jin
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Centre for Vision Research, Westmead Millennium Institute of Medical Research, University of Sydney, Sydney, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.affiliation: School of Medicine and Pharmacology, The University of Western Australia, Crawley, WA, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Prince
authors.affiliation: School of Medicine and Pharmacology, The University of Western Australia, Crawley, WA, Australia.
authors.forename: Wai Hon
authors.initials: WH
authors.lastname: Lim
authors.affiliation: School of Medicine and Pharmacology, The University of Western Australia, Crawley, WA, Australia.
authors.forename: Joshua
authors.initials: J
authors.lastname: Lewis
authors.affiliation: Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Chapman
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Craig
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors
keywords: Cancer epidemiology; Chronic kidney disease; Survival analyses