Albuminuria, eGFR, and Cancer Risk: The Chronic Kidney Disease Prognosis Consortium

Background: Studies examining the association of chronic kidney disease (CKD) with cancer risk have demonstrated conflicting results. We quantified the independent associations of albuminuria and estimated glomerular filtration rate (eGFR) with cancer risk overall and among selected site-specific cancers in the CKD Prognosis Consortium (48 cohorts). Methods: We performed individual-participant data meta-analysis of 715,713 individuals without a history of cancer. Adjusted Cox models were used to quantify the associations of urine albumin-to-creatinine ratio (ACR) and serum creatinine-based eGFR with overall and site-specific cancer risk. Results: 94,417 incident cancer cases occurred during 17,416,991 person-years of follow-up (incidence rate of 22.2 per 1000 person-years). Higher ACR was positively associated with cancer risk [HR 1.07 (1.05-1.09 per 8-fold increase in ACR], whereas no consistent association of eGFR with cancer risk was seen [HR 1.01 (0.99 - 1.03) per 15 ml decrease in eGFR]. For the cross-categories of ACR and eGFR, higher ACR was associated with higher risk for overall cancer risk, irrespective of eGFR levels. For site-specific cancer, lower eGFR showed a significant association with urological cancer, multiple myeloma, and prostate cancer, whereas higher ACR was related to many types of cancer (i.e., head/neck, colorectal, liver, pancreas, lung, hemolymphatic, leukemia, and multiple myeloma), in addition to kidney-related cancer. Results were similar after excluding incident cases within 1 year to minimize the possibility of reverse causation. Conclusion: CKD measures, particularly albuminuria, were independently associated with subsequent risk of cancer. Our result warrant investigation into the pathways from albuminuria to cancer. Funding: NIDDK Support, Private Foundation Support