The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Department of Cardiology, New Tokyo Hospital, Matsudo, Japan.
BMJ Open. 2022 Apr 4;12(4):e056250. doi: 10.1136/bmjopen-2021-056250.
This study aimed to assess whether adults with proteinuria were at a higher risk of incident colorectal cancer (CRC) than those without proteinuria using a large-scale population-based database.
A retrospective observational study.
The JMDC Claims Database, an administrative health claims database, was used. Data were collected between 2005 and 2020.
We selected records of participants (n=3 543 705) who underwent health check-ups, including physical examinations, blood tests and urine dipstick tests. We excluded participants who were aged <20 years (n=25 577), had a history of CRC, colorectal disease, renal disease and renal replacement therapy (n=114 888), or had missing data on medications (n=170 145), cigarette smoking (n=14 835), alcohol consumption (n=366 414) or physical activity (n=106 550). Finally, we analysed 2 745 296 participants.
The primary outcome was CRC at any stage.
Participants were categorised as having no proteinuria (n=2 435 872), trace proteinuria (n=231 153) or positive proteinuria (n=78 271). Over a mean follow-up period of 1189±914 days, 10 615 CRC diagnoses were recorded. The incidence of CRC (95% CI) was lowest in participants without proteinuria (11.7; 95% CI, 11.5 to 11.9 per 10 000 person-years), followed by trace proteinuria (12.5; 95% CI, 11.7 to 13.3 per 10 000 person-years) and positive proteinuria (16.1; 95% CI, 14.6 to 17.7 per 10 000 person-years). After multivariable adjustment, compared with no proteinuria, HRs for incident CRC were 1.20 (95% CI, 1.12 to 1.29) and 1.23 (95% CI, 1.11 to 1.36) for trace and positive proteinuria, respectively. The association between proteinuria and incident CRC existed in participants after multiple imputations for missing data, with a follow-up period of ≥365 days, regardless of age, sex, obesity, hypertension, diabetes mellitus and estimated glomerular filtration rate.
Trace and positive proteinuria were associated with a greater risk of incident CRC. Assessment of proteinuria could help identify individuals at an increased risk of CRC.
本研究旨在利用大规模人群数据库评估蛋白尿患者发生结直肠癌（CRC）的风险是否高于无蛋白尿患者。
回顾性观察性研究。
使用 JMDC 理赔数据库，这是一个行政健康理赔数据库。数据收集于 2005 年至 2020 年。
我们选择了（n=3543705）接受健康检查的参与者记录，包括体检、血液检查和尿液试纸检查。我们排除了年龄<20 岁（n=25577）、有 CRC、结直肠疾病、肾脏疾病和肾脏替代治疗史（n=114888）或药物使用数据缺失（n=170145）、吸烟（n=14835）、饮酒（n=366414）或体力活动（n=106550）的参与者。最后，我们分析了 2745296 名参与者。
主要结局是任何阶段的 CRC。
参与者被分为无蛋白尿（n=2435872）、微量蛋白尿（n=231153）或阳性蛋白尿（n=78271）。在平均 1189±914 天的随访期间，记录了 10615 例 CRC 诊断。无蛋白尿患者的 CRC 发生率（95%CI）最低（11.7；95%CI，11.5 至 11.9/10000 人年），其次是微量蛋白尿（12.5；95%CI，11.7 至 13.3/10000 人年）和阳性蛋白尿（16.1；95%CI，14.6 至 17.7/10000 人年）。多变量调整后，与无蛋白尿相比，微量蛋白尿和阳性蛋白尿的 CRC 发病风险 HR 分别为 1.20（95%CI，1.12 至 1.29）和 1.23（95%CI，1.11 至 1.36）。蛋白尿与 CRC 发病的关联在缺失数据进行多次插补、随访时间≥365 天的参与者中仍然存在，且与年龄、性别、肥胖、高血压、糖尿病和估计肾小球滤过率无关。
微量蛋白尿和阳性蛋白尿与 CRC 发病风险增加相关。评估蛋白尿可能有助于识别 CRC 风险增加的个体。
