Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
BMC Cancer. 2023 Sep 7;23(1):839. doi: 10.1186/s12885-023-11329-9.
Colorectal cancer survival has improved in recent decades but there are concerns that survivors may develop kidney problems due to adverse effects of cancer treatment or complications of the cancer itself. We quantified the risk of acute kidney injury (AKI) in colorectal cancer survivors compared to people with no prior cancer.
Retrospective matched cohort study using electronic health record primary care data from the Clinical Practice Research Datalink GOLD linked to hospital data in England (HES-APC). Individuals with colorectal cancer between 1997-2018 were individually matched on age, sex, and GP practice to people with no prior cancer. We used Cox models to estimate hazard ratios for an incident hospital diagnosis of AKI in colorectal cancer survivors compared to individuals without cancer, overall and stratified by time since diagnosis adjusted for other individual-level factors (adj-HR).
Twenty thousand three hundred forty colorectal cancer survivors were matched to 100,058 cancer-free individuals. Colorectal cancer survivors were at increased risk of developing AKI compared to people without cancer (adj-HR = 2.16; 95%CI 2.05-2.27). The HR was highest in the year after diagnosis (adj-HR 7.47, 6.66-8.37), and attenuated over time, but there was still increased AKI risk > 5 years after diagnosis (adj-HR = 1.26, 1.17-1.37). The association between colorectal cancer and AKI was greater for younger people, men, and those with pre-existing chronic kidney disease.
Colorectal cancer survivors were at increased risk of AKI for several years after cancer diagnosis, suggesting a need to prioritise monitoring, prevention, and management of kidney problems in this group of cancer survivors.
近年来，结直肠癌的生存率有所提高，但人们担心由于癌症治疗的不良反应或癌症本身的并发症，幸存者可能会出现肾脏问题。我们量化了与无既往癌症的人群相比，结直肠癌幸存者发生急性肾损伤（AKI）的风险。
这是一项使用临床实践研究数据链接（Clinical Practice Research Datalink GOLD）与英格兰医院数据（HES-APC）链接的电子健康记录初级保健数据进行的回顾性匹配队列研究。1997-2018 年间患有结直肠癌的个体按年龄、性别和全科医生实践与无既往癌症的个体进行个体匹配。我们使用 Cox 模型估计结直肠癌幸存者与无癌症个体发生 AKI 的发生率比值比（HR），总体分析以及按诊断后时间分层分析（调整其他个体水平因素后的调整 HR（adj-HR））。
2340 名结直肠癌幸存者与 100058 名无癌症个体相匹配。与无癌症个体相比，结直肠癌幸存者发生 AKI 的风险增加（adj-HR=2.16；95%CI 2.05-2.27）。诊断后 1 年 HR 最高（adj-HR 7.47，6.66-8.37），随着时间的推移逐渐减弱，但在诊断后 5 年以上仍存在 AKI 风险增加（adj-HR=1.26，1.17-1.37）。结直肠癌与 AKI 的相关性在年轻人、男性和有既往慢性肾脏病的患者中更大。
在癌症诊断后几年内，结直肠癌幸存者发生 AKI 的风险增加，这表明需要优先监测、预防和管理这组癌症幸存者的肾脏问题。
