Cancer, especially multiple myeloma, linked to increased likelihood of kidney failure
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Patients with newly diagnosed cancer were more likely to develop kidney failure than a group of controls without cancer who exhibited similar characteristics in terms of age, sex, eGFR and the presence of diabetes or hypertension.
Findings from the retrospective population-based study, which matched each patient with cancer to two controls, further revealed that multiple myeloma conferred the greatest risk.
“Previous studies have shown an increased cancer risk within the dialysis and kidney transplant populations compared to the general population. However, it is unclear whether cancer increases the risk of kidney failure,” Chang Seong Kim, MD, PhD, of the department of internal medicine at Chonnam National University Medical School in Gwangju, Korea, and colleagues wrote. “This population-based cohort study was conducted using the Korean National Health Insurance Service database and compared approximately 825,000 patients with cancer to twice as many patients without cancer but matched on other characteristics.”
Matching and subgroup analyses
In addition to matching based on age, sex, eGFR and diabetes or hypertension status, the researchers conducted subgroup analyses in which they accounted for smoking status, alcohol consumption, BMI and waist circumference.
The primary outcome of the study was the development of kidney failure treated with kidney replacement therapy (KFRT), including the initiation of dialysis (peritoneal or hemodialysis) or transplant.
“Since a mortality event could compete with our outcome of interest, we performed competing risk analysis using the Fine and Gray’s model, which estimates the proportional sub-distribution hazard of the event of interest,” the researchers wrote.
During a median follow-up of 5.2 years (or a total of 12,877,386 person-years), 4,188 participants with cancer and 4,534 participants without cancer developed kidney failure.
Results demonstrated that the occurrence of kidney failure was higher in patients with cancer than in non-cancer controls (incidence rates of 1.07 vs. 0.51 cases per 1,000 person-years), with the competing risk analysis showing that cancer was significantly associated with an increased risk after adjusting for other potential predictors and excluding newly developed cancer cases in the non-cancer group during follow-up (adjusted hazard ratio = 2.29). All patient subgroups (eg, age, sex, smoking, alcohol, exercise, obesity and comorbid conditions) exhibited a higher risk of kidney failure if cancer was also present.
Kidney failure risk based on cancer type
Of all cancer subtypes, multiple myeloma conferred the greatest risk for kidney failure (aHR = 18.97); this was followed by leukemia, lymphoma, kidney cancer, ovarian cancer and liver cancer.
Researchers also observed that the risk for kidney failure was higher for patients with hematologic malignancies than for those with solid cancers; the solid cancers most strongly associated with kidney failure included those originating in the kidney, liver, ovary, cervix, bladder, uterus and esophagus. No significant associations were found between cancers of the pancreas, lung, skin, oral cavity, larynx and nerves and the risk for kidney failure.
“In conclusion, onco-nephrology is an emerging and expanding field, that is gaining more attention as the prevalence of cancer increases,” Seong Kim and colleagues wrote. “ ... The presence of kidney failure has significant influence on the treatment options available to the cancer patients, including certain chemotherapeutic agents, hematopoietic stem cell transplantation, and surgery, and affects overall cancer-related survival. Therefore, it is crucial for nephrologists and oncologists to be aware of the risk of KFRT in cancer patients to develop better preventive strategies.”
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