Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, New South Wales, Australia; Institute for Social- and Preventive Medicine, University Bern, Bern, Switzerland.
Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, New South Wales, Australia; School of Public Health, University of Sydney, New South Wales, Australia.
Am J Kidney Dis. 2014 Jan;63(1):23-30. doi: 10.1053/j.ajkd.2013.07.008. Epub 2013 Aug 30.
Chronic kidney disease is associated with an increased risk of cancer, but whether reduced kidney function also leads to increased cancer mortality is uncertain. The aim of our study was to assess the independent effects of reduced kidney function on the risk of cancer deaths.
Prospective population-based cohort study.
SETTING & PARTICIPANTS: Participants of the Blue Mountains Eye Study (n=4,077; aged 49-97 years).
Estimated glomerular filtration rate (eGFR).
Overall and site-specific cancer mortality.
During a median follow-up of 12.8 (IQR, 8.6-15.8) years, 370 cancer deaths were observed in our study cohort. For every 10-mL/min/1.73 m(2) reduction in eGFR, there was an increase in cancer-specific mortality of 18% in the fully adjusted model (P<0.001). Compared with participants with eGFR ≥ 60 mL/min/1.73 m(2), the adjusted HR for cancer-specific mortality for those with eGFR<60 mL/min/1.73 m(2) was 1.27 (95% CI, 1.00-1.60; P=0.05). This excess cancer mortality varied with site, with the greatest risk for breast and urinary tract cancer deaths (adjusted HRs of 1.99 [95% CI, 1.05-3.85; P=0.01] and 2.54 [95% CI, 1.02-6.44; P=0.04], respectively).
Residual confounding, such as from unmeasured socioeconomic factors and the potential effects of erythropoiesis-stimulating agents on cancer deaths, may have occurred.
eGFR<60 mL/min/1.73m(2) appears to be a significant risk factor for death from cancer. These effects appear to be site specific, with breast and urinary tract cancers incurring the greatest risk of death among those with reduced kidney function.
慢性肾脏病与癌症风险增加相关，但肾功能下降是否也会导致癌症死亡率增加尚不确定。本研究旨在评估肾功能下降对癌症死亡风险的独立影响。
前瞻性基于人群的队列研究。
蓝山眼研究（n=4077；年龄 49-97 岁）的参与者。
估算肾小球滤过率（eGFR）。
在中位随访 12.8 年（IQR，8.6-15.8 年）期间，我们的研究队列中观察到 370 例癌症死亡。在完全调整模型中，eGFR 每降低 10-mL/min/1.73 m(2)，癌症特异性死亡率增加 18%（P<0.001）。与 eGFR≥60 mL/min/1.73 m(2)的参与者相比，eGFR<60 mL/min/1.73 m(2)的参与者癌症特异性死亡率的调整 HR 为 1.27（95%CI，1.00-1.60；P=0.05）。这种癌症死亡的增加与部位有关，乳腺癌和泌尿系统癌症死亡的风险最大（调整后的 HR 分别为 1.99（95%CI，1.05-3.85；P=0.01）和 2.54（95%CI，1.02-6.44；P=0.04））。
可能存在残余混杂因素，例如无法测量的社会经济因素以及促红细胞生成素刺激剂对癌症死亡的潜在影响。
eGFR<60 mL/min/1.73 m(2)似乎是癌症死亡的一个重要危险因素。这些影响似乎具有特定部位的特征，在肾功能下降的患者中，乳腺癌和泌尿系统癌症的死亡风险最大。
