The risk of cancer in people with diabetes and chronic kidney disease

Wong, Germaine
Zoungas, Sophia
Lo, Serigne
Chalmers, John
Cass, Alan
Neal, Bruce
Woodward, Mark
Perkovic, Vlado
Glasziou, Paul
Williams, Bryan
Howard, Kirsten
Chapman, Jeremy R.
Craig, Jonathan C.

¹Centre for Kidney Research and Kids Research Institute, The Children's Hospital at Westmead, Sydney, Australia
²School of Public Health, University of Sydney, Sydney, Australia
³Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
⁴The George Institute for Global Health, University of Sydney, Sydney, Australia
⁵School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
⁶Centre for Research in Evidence-Based Practice, Faculty of Health Sciences, Bond University, Gold Coast, Australia
⁷Department of Cardiovascular Sciences, University of Leicester, Clinical Sciences Wing, Glenfield General Hospital, Leicester, UK

Correspondence and offprint requests to: Germaine Wong; E-mail: [email protected]

Received November 15, 2011

Accepted January 16, 2012

Nephrology Dialysis Transplantation 27(8):p 3337-3344, August 2012. | DOI: 10.1093/ndt/gfs022

Background

Diabetes and chronic kidney disease (CKD) are both associated with an increased risk of cancer but it is unclear whether diabetes complicated by CKD further augments an individual's cancer risk. The aim of our study was to determine the association of CKD [defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min] with the overall and site-specific risks of incident cancers among individuals with Type 2 diabetes.

Methods

Cox proportional hazard regression models and competing risk analyses were used to examine the univariate and multivariate adjusted associations between reduced kidney function and the overall and site-specific risks of cancer in participants enrolled in the Action in Diabetes and Vascular disease: Preterax and Diamicron MR controlled evaluation (ADVANCE) trial.

Results

Over a median follow-up of 5.0 years, 700 malignant neoplasms occurred in the 11 140 (6.4%) participants. There was no increase in overall cancer risk [adjusted hazard ratio: 1.07 (95% confidence interval: 0.89–1.29, P = 0.50)] or site-specific cancer risk for individuals with CKD (defined as eGFR < 60 mL/min) compared to those without CKD at baseline. These results were robust to multiple methods and thresholds used to estimate CKD.

Conclusions

Mild to moderate CKD does not increase the risk of cancer in people with Type 2 diabetes. ADVANCE is registered with ClincalTrial.gov (number NCT00145925).