Mok Yejin, Surapaneni Aditya, Sang Yingying, Coresh Josef, Grams Morgan E, Matsushita Kunihiro, Ballew Shoshana H, Alencar de Pinho Natalia, Ärnlöv Johan, Barreto Sandhi M, Bell Samira, Brenner Hermann, Carrero Juan-Jesus, Chinnadurai Rajkumar, Ciemins Elizabeth, Gansevoort Ron T, Jassal Simerjot K, Jung Keum Ji, Kirchner H Lester, Konta Tsuneo, Kovesdy Csaba P, Luo Li, Pandit Krutika, Rahman Mahboob, Robinson-Cohen Cassianne, Sabanayagam Charumathi, Schultheiss Ulla T, Shlipak Michael, Staplin Natalie, Tonelli Marcello, Wang Angela Yee-Moon, Wen Chi-Pang, Woodward Mark, Lees Jennifer S
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and Welch Center for Prevention, Epidemiologyand Clinical Research, Baltimore, MD, USA.
Division of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
Br J Cancer. 2025 Sep 6. doi: 10.1038/s41416-025-03140-z.
Studies examining the association of chronic kidney disease (CKD) with cancer risk have demonstrated conflicting results.
This was an individual participant data meta-analysis including 54 international cohorts contributing to the CKD Prognosis Consortium. Included cohorts had data on albuminuria [urine albumin-to-creatinine ratio (ACR)], estimated glomerular filtration rate (eGFR), overall and site-specific cancer incidence, and established risk factors for cancer. Included participants were aged 18 years or older, without previous cancer or kidney failure.
Among 1,319,308 individuals, the incidence rate of overall cancer was 17.3 per 1000 person-years. Higher ACR was positively associated with cancer risk [adjusted hazard ratio 1.08 (95% CI 1.06-1.10) per 8-fold increase in ACR]. No association of eGFR with overall cancer risk was seen. For site-specific cancers, lower eGFR was associated with urological cancer and multiple myeloma, whereas higher ACR was associated with many cancer types (kidney, head/neck, colorectal, liver, pancreas, bile duct, stomach, larynx, lung, hemolymphatic, leukaemia, and multiple myeloma). Results were similar in a 1-year landmark analysis.
Albuminuria, but not necessarily eGFR, was independently associated with the subsequent risk of cancer. Our results warrant an investigation into mechanisms that explain the link between albuminuria and cancer.
关于慢性肾脏病（CKD）与癌症风险之间关联的研究结果相互矛盾。
这是一项个体参与者数据的荟萃分析，纳入了为CKD预后联盟做出贡献的54个国际队列。纳入的队列具有蛋白尿[尿白蛋白与肌酐比值（ACR）]、估算肾小球滤过率（eGFR）、总体及特定部位癌症发病率以及已确定的癌症风险因素的数据。纳入的参与者年龄在18岁及以上，无既往癌症或肾衰竭病史。
在1,319,308名个体中，总体癌症发病率为每1000人年17.3例。较高的ACR与癌症风险呈正相关[ACR每增加8倍，调整后的风险比为1.08（95%CI 1.06 - 1.10）]。未发现eGFR与总体癌症风险有关联。对于特定部位癌症，较低的eGFR与泌尿系统癌症和多发性骨髓瘤相关，而较高的ACR与多种癌症类型相关（肾脏、头颈部、结肠直肠、肝脏、胰腺、胆管、胃、喉、肺、血液淋巴系统、白血病和多发性骨髓瘤）。在1年的标志性分析中结果相似。
蛋白尿而非eGFR与后续癌症风险独立相关。我们的结果值得对解释蛋白尿与癌症之间联系的机制进行研究。
