Kidney Week

Abstract: FR-PO225

Incidence of Cancer in People with CKD: A Systematic Review

Session Information

• Onconephrology: Immunotherapy Nephrotoxicity and Assessment of GFR
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Onconephrology

• 1700 Onconephrology

Authors

• Elyan, Benjamin Michael Peter, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, United Kingdom

Benjamin Michael Peter Elyan, MBChB

• Tan, Beatrix, Ninewells Hospital and Medical School, Dundee, United Kingdom

Beatrix Tan, MBChB

• Lambourg, Emilie, University of Dundee Division of Population Health and Genomics, Dundee, United Kingdom

Emilie Lambourg, PharmD

• Jones, Robert John, Beatson West of Scotland Cancer Centre, Glasgow, Glasgow, United Kingdom

Robert John Jones, MBChB, PhD

• Mcallister, David A., University of Glasgow School of Health and Wellbeing, Glasgow, Glasgow, United Kingdom

David A. Mcallister, MD, MBChB, MPH

• Lang, Ninian N., University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, United Kingdom

Ninian N. Lang, MBChB, PhD

• Mark, Patrick Barry, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, United Kingdom

Patrick Barry Mark, MBChB, PhD

• Lees, Jennifer S., University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, United Kingdom

Jennifer S. Lees, MA, MBChB, PhD

• Bell, Samira, Ninewells Hospital and Medical School, Dundee, United Kingdom

Samira Bell, MD, MBChB

Background

Cancer incidence in people with chronic kidney disease (CKD) who do not require kidney replacement therapy remains inadequately characterised. This systematic review aimed to estimate cancer risk in people with CKD.

Methods

A systematic search of three online bibliographic databases until January 17, 2023, identified studies reporting cancer incidence in CKD cohorts (PROSPERO CRD42022359690). Meta-analyses using inverse variance method compared incidence rates in individuals with low eGFR (<60mL/min/1.73m2) with available cohorts with normal eGFR (≥60mL/min/1.73m2 or both 60-89 and ≥90mL/min/1.73m²) for all cancers and site-specific cancers. Multiple meta-regression analyses explored associations of eGFR and age.

Results

In 27 studies (5,519,778 people with CKD), from 10 countries spanning 2009-2022, incidence rates of cancer were associated with worse CKD severity. Incidence rate ratio (IRR) comparing people with an eGFR <60mL/min/1.73m2 to ≥60mL/min/1.73m2 was 1.35 [95% CI:1.12-1.63, p=0.002, I²=99.9%]. People with eGFR <60mL/min/1.73m2 were at elevated rate of cancer compared with eGFR ≥90mL/min/1.73m² (IRR 1.48 [95% CI:1.04-2.10, p=0.03, I²=100%]) and those with eGFR 60-89mL/min/1.73m² (IRR 1.21 [95% CI:1.11-1.33, p<0.01, I²=92%]). Age was associated with increased cancer incidence (β=0.31, p=0.02) on multiple meta-regression analysis. There was no association between site-specific cancer incidence in CKD patients, but these had wide confidence intervals.

Conclusion

Individuals with CKD have an elevated incidence of cancer, with increasing age contributing to this association. These findings emphasise the importance of investigating whether CKD independently elevates cancer risk, building evidence for tailored cancer screening into CKD patient care.

Forest plot showing the pooled incidence rate ratios for people with eGFR <60mL/min/1.73m2 vs ≥60mL/min/1.73m2