Kidney Week

Abstract: TH-OR39

CKD Prevalence, Patterns of Treatment, and Outcomes in Patients with Cancer: A Population-Based Cohort Study

Session Information

• Onco-Nephrology Updates in Practice
  October 22, 2020 | Location: Simulive
  Abstract Time: 05:00 PM - 07:00 PM

Category: Onco-Nephrology

• 1500 Onco-Nephrology

Authors

• Kitchlu, Abhijat, University Health Network, Toronto, Ontario, Canada

Abhijat Kitchlu, MD, MS



Dr. Abhijat Kitchlu completed medical school at Western University, followed by postgraduate training in internal medicine and nephrology at the University of Toronto. He then completed a Master's in Clinical Epidemiology at the University of Toronto as part of the Clinician Scientist Training Program. He is currently a Staff Nephrologist and Director of the Onco-nephrology Program at the University Health Network in Toronto. He is an Assistant Professor in the Department of Medicine at the University of Toronto. His research and clinical interest include onco-nephrology (co-existing cancer and kidney disease), with specific focus on toxicities of cancer therapies and cancer treatment options in the setting of chronic kidney disease. He also has interest and expertise in the use of population-level healthcare administrative data for clinical research.

• Luo, Bin, Institute for Clinical Evaluative Sciences, London, Ontario, Canada

Bin Luo,

• Jeyakumar, Nivethika, Institute for Clinical Evaluative Sciences, London, Ontario, Canada

Nivethika Jeyakumar,

• Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada

Amit X. Garg,

• Amir, Eitan, University Health Network, Toronto, Ontario, Canada

Eitan Amir,

• Kim, Joseph, University Health Network, Toronto, Ontario, Canada

Joseph Kim,

• Wald, Ron, St. Michael's Hospital, Toronto, Ontario, Canada

Ron Wald,

Background

Chronic kidney disease (CKD) may impede optimal cancer treatment and result in worse outcomes. There are limited data to assess receipt of systemic therapy, radiation therapy, and palliative care in patients with cancer and CKD.

Methods

We conducted a population-based cohort study of all patients (≥18 years old) with a new cancer diagnosis in Ontario, Canada (2007-2015). We categorized patients according to CKD status at cancer diagnosis [estimated glomerular filtration rate (eGFR) ≥60 (referent group), 45-59, 30-44, 15-29, <15 mL/min/1.73m², dialysis and transplant recipients]. We used multivariable Fine and Gray proportional hazards models to assess overall survival, receipt of systemic therapy, radiation and palliative care (6-months prior to death) in the 5 most common solid cancers (bladder, breast, colon, prostate, lung) and kidney cancer.

Results

We identified 128,489 patients with a new cancer diagnosis, of whom 16% had pre-existing CKD (eGFR <60 mL/min/1.73m²). Patients with the 6 cancers of interest accounted for 73% (93,751). Kidney function at cancer diagnosis was associated with (progressively) worse overall survival in CKD stages 3a-5, dialysis, and transplant recipients (Figure a). Increasing CKD stage was associated with significantly reduced receipt of all treatment modalities [systemic therapy, radiation and palliative care (Figure b-d)]. Patients receiving dialysis had 2-fold increased mortality in bladder, breast and colon cancers, and 3-fold mortality in kidney cancers.

Conclusion

In patients with cancer, CKD is associated with reduced exposure to systemic, radiation and palliative treatments and worse overall survival. Strategies to improve cancer care in the CKD population are needed.

Figure - Adjusted HR by CKD Status