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Kidney Function, Proteinuria, and Cancer Incidence: The Korean Heart Study

Authors
 Yejin Mok  ;  Kunihiro Matsushita  ;  Shoshana H. Ballew  ;  Yingying Sang  ;  Keum Ji Jung  ;  Sunmi Lee  ;  Sun Ha Jee  ;  Josef Coresh 
Citation
 American Journal of Kidney Diseases, Vol.70(4) : 512-521, 2017 
Journal Title
 American Journal of Kidney Diseases 
ISSN
 0272-6386 
Issue Date
2017
MeSH
Adult ; Aged ; Female ; Glomerular Filtration Rate* ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasms/complications* ; Neoplasms/epidemiology* ; Prospective Studies ; Proteinuria/complications* ; Renal Insufficiency, Chronic/complications* ; Renal Insufficiency, Chronic/physiopathology*
Keywords
Estimated glomerular filtration rate (eGFR) ; cancer ; cohort study ; kidney function ; proteinuria ; renal damage ; urine dipstick
Abstract
BACKGROUND: Reported associations of estimated glomerular filtration rate (eGFR) with cancer risk are inconsistent, and data for the proteinuria-cancer relationship are sparse. We sought to quantify the associations of cancer incidence with eGFR and with proteinuria in a large population-based cohort. STUDY DESIGN: A prospective cohort study. SETTING & PARTICIPANTS: 242,583 adults (30-74 years old) without a diagnosis of cancer at baseline in the Korean Heart Study, based on health checkups in 1996 to 2004 with follow-up until 2012. PREDICTORS: Creatinine-based eGFR (≥90, 60-89, 45-59, and <45mL/min/1.73m2) and dipstick proteinuria (undetectable/trace, 1+, 2+, and ≥3+). OUTCOMES: Overall and site-specific cancer incidence based on ICD-10 codes. RESULTS: 15,165 cases of cancer were detected. The relationship between eGFR and incidence of any cancer was J shaped, with the lowest risk at 45 to 59mL/min/1.73m2. There was 44% higher risk for any cancer among those with eGFRs<45mL/min/1.73m2 compared with those with eGFRs≥90mL/min/1.73m2 (HR, 1.44; 95% CI, 1.11-1.87). High proteinuria was also associated with cancer risk, showing a dose-response relationship (HRs of 1.24 [95% CI, 1.13-1.35], 1.38 [95% CI, 1.17-1.63], and 1.66 [95% CI, 1.30-2.12] for 1+, 2+, and ≥3+ vs undetectable/trace). Examining site-specific cancer, eGFR<45 (vs ≥45) mL/min/1.73m2 was significantly associated with kidney and ureteral cancer, multiple myeloma, and leukemia, whereas proteinuria ≥ 1+ (vs undetectable/trace) was related to a broader set of cancers (ie, stomach, rectal, liver, lung, ovarian, kidney, bladder, and multiple myeloma). After excluding study participants with follow-up less than 3 years, the associations remained consistent for kidney cancer and myeloma with eGFR and for rectal, liver, lung, and ovarian cancer with proteinuria. LIMITATIONS: Relatively small number of participants with severely reduced eGFR or 70 years or older. CONCLUSIONS: Kidney measures, particularly proteinuria, were associated with increased incidence of cancer. Future studies are needed to better understand the pathophysiologic mechanisms underlying these associations.
Full Text
https://www.sciencedirect.com/science/article/pii/S0272638617306364
DOI
10.1053/j.ajkd.2017.03.018
Appears in Collections:
4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원) > 1. Journal Papers
Yonsei Authors
Jung, Keum Ji(정금지) ORCID logo https://orcid.org/0000-0003-4993-0666
Jee, Sun Ha(지선하) ORCID logo https://orcid.org/0000-0001-9519-3068
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/161772
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