Increased Risks of Urinary Tract Cancers in Advanced CKD

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Patients with moderate to severe chronic kidney disease (CKD) are at elevated risk of kidney cancer and urothelial carcinoma, according to a paper in Nephrology Dialysis Transplantation.

The researchers performed a systematic review of the literature to identify studies of incident urinary tract malignancies associated with CKD. The review identified six studies including more than 8.6 million individuals with moderate to severe CKD, excluding those receiving dialysis or kidney transplant. Associations with kidney cancer and urothelial carcinoma were analyzed, including the effects of CKD severity.

In general, risk of urinary tract cancers increased along with CKD severity. The presence of CKD was associated with a threefold increase in kidney cancer (incidence rate ratio [IRR], 3.36) and a fourfold increase in urothelial malignancy (IRR, 3.96).

After adjustment for confounding factors known to affect kidney or urothelial cancer risk, CKD-associated hazard ratios (HRs) were 3.36 for kidney cancer and 1.40 for urothelial malignancy. The increases were significant for stage 3 CKD (kidney cancer: HR, 1.89 and urothelial malignancy: HR, 1.40) and stages 4/5 CKD (kidney cancer: HR, 2.30 and urothelial malignancy: HR, 1.24).

End stage kidney disease is associated with increased risk of kidney or urothelial cancer. However, less is known about cancer risks associated with non-end stage CKD. Some studies have reported increased malignancy risks even after adjustment for shared risk factors, such as diabetes and hypertension.

Based on the new meta-analysis, ā€œEven moderate CKD is associated with elevated risk of kidney cancer and UC [urothelial carcinoma],ā€ the researchers write. They discuss the implications for assessment and monitoring of patients with CKD, especially those with persistent or worsening hematuria [Brooks ER, et al. Chronic kidney disease and risk of kidney or urothelial malignancy: Systematic review and meta-analysis. Nephrol Dial Transpl, published online November 30, 2023. doi: 10.1093/ndt/gfad249].