OAKLAND, Calif. – Chronic kidney disease is associated with a higher risk of kidney and urothelial cancer, but not other types of cancer, according to research being presented this week at the American Society of Clinical Oncology’s Genitourinary Cancers Symposium in San Francisco. Urothelial cancers affect the bladder, ureters, and renal pelvis.
Researchers from Huntsman Cancer Institute at the University of Utah and Kaiser Permanente’s Northern California Division of Research found that higher risk for kidney cancer and urothelial cancer is associated specifically with chronic kidney disease as measured by a reduced flow rate of filtered fluid through the kidneys. The researchers found no significant associations with prostate, colorectal, lung, breast, or any other cancers.
"We’ve known for some time that the incidence of chronic kidney disease continues to rise and that an estimated 11.5 percent of the United States population has reduced kidney function,” said William T. Lowrance, MD, with Huntsman Cancer Institute and lead author of the research. “We also know from previous research that there are higher risks of cancer in people with end-stage renal disease requiring dialysis or transplantation.”
“What we haven’t known is whether less severe kidney disease is independently associated with cancer,” said Alan S. Go, acting director of the Kaiser Permanente Division of Research, and the senior author of the abstract being presented this week. “These findings describe an association that could have important public health implications for screening and early detection of cancer in the growing number of patients with chronic kidney disease.”
Researchers evaluated the association between chronic kidney disease and the risk of incident cancer in a large, diverse, community-based population linked to a regional cancer registry. As was hypothesized, they found an independent, graded increased risk of kidney cancer with lower estimated glomerular filtration rate, the flow rate at which the kidneys filter fluid. The study examined all people with measured kidney function who are receiving care within Kaiser Permanente Northern California, a large, integrated health care delivery system providing care to 3.2 million members. The Kaiser Permanente Cancer Registry links to the National Cancer Institute-sponsored Surveillance, Epidemiology, and End Results (SEER) Cancer Registry that collects detailed data on incident cancer site, initial treatment and other patient characteristics.
Research scientists adjusted for a large set of factors that may confound the relationship between level of kidney function and cancer risk. The risk of renal cancer retained a robust and graded association with renal function. As chronic kidney disease worsened, the risk of renal cancer increased, they explained. There was a similar association between estimated GFR and urinary tract (excluding prostate) cancer, although the magnitude of this association was less pronounced than observed with renal cancer, they added.
Additional authors on the study include Natalia Udaltsovea, PhD;with the Kaiser Permanente Division of Research; Juan Ordonez, MD, with the Kaiser Permanente Oakland Medical Center department of nephrology; and Paul Russo, MD, with Memorial Sloan-Kettering Cancer Center Department of Surgery. The study was funded by the Sidney Kimmel Center for Prostate and Urologic Cancers and the National Institute of Diabetes and Digestive and Kidney Diseases.