Received September 22, 2008
Accepted on January 12, 2009

CLINICAL EPIDEMIOLOGY

Association of CKD and Cancer Risk in Older People

Germaine Wong ^*1, Andrew Hayen , Jeremy R. Chapman , Angela C. Webster ^*, Jie Jin Wang , Paul Mitchell ^||, and Jonathan C. Craig ^*

*National Health and Medical Research Council Centre for Clinical Research Excellence in Renal Medicine, Children’s Hospital at Westmead, and Centre for Transplant and Renal Research, Westmead Hospital, Westmead, and School of Public Health and ||Centre for Vision Research, Department of Ophthalmology and the Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, and Centre for Eye Research Australia, Department of Ophthalmology, University of Melbourne, Melbourne, Victoria, Australia

¹ To whom correspondence should be addressed. E-mail: germainw{at}chw.edu.au.

	Abstract

People with ESRD are at increased risk for cancer, but it is uncertain when this increased risk begins in the spectrum of chronic kidney disease (CKD). The aim of our study was to determine whether moderate CKD increases the risk for cancer among older people. We linked the Blue Mountains Eye Study, a prospective population-based cohort study of 3654 residents aged 49 to 97 yr, and the New South Wales Cancer Registry. During a mean follow-up of 10.1 yr, 711 (19.5%) cancers occurred in 3654 participants. Men but not women with at least stage 3 CKD had a significantly increased risk for cancer (test of interaction for gender P = 0.004). For men, the excess risk began at an estimated GFR (eGFR) of 55 ml/min per 1.73 m² (adjusted hazard ratio [HR] 1.39; 95% confidence interval [CI] 1.00 to 1.92) and increased linearly as GFR declined. For every 10-ml/min decrement in eGFR, the risk for cancer increased by 29% (adjusted HR 1.29; 95% CI 1.10 to 1.53), with the greatest risk at an eGFR <40 ml/min per 1.73 m² (adjusted HR 3.01; 95% CI 1.72 to 5.27). The risk for lung and urinary tract cancers but not prostate was higher among men with CKD. In conclusion, moderate CKD (stage 3) may be an independent risk factor for the development of cancer among older men but not women, and the effect of CKD on risk may vary for different types of cancer.