Albuminuria, Kidney Function, and Cancer Risk in the Community
Albuminuria, Kidney Function, and Cancer Risk in the Community
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DOI：
10.1093/aje/kwaa043
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发表时间：
2020-09-01
影响因子：
5
通讯作者：
Matsushita, Kunihiro
中科院分区：
文献类型：
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作者：
Mok, Yejin;Ballew, Shoshana H.;Matsushita, Kunihiro
很少有研究全面调查肾小球滤过率（eGFR）和尿白蛋白与肌酐比值（ACR）这两项关键肾脏疾病指标与癌症发病率的关系。在社区动脉粥样硬化风险研究的基线（1996-1998）8,935名参与者中，我们使用Cox回归模型对潜在混杂因素进行校正，量化了eGFR（基于肌酐和胱抑素C）和ACR与癌症风险的关系。由于随访期间前列腺癌筛查指南的变化，我们调查了总体癌症、总体非前列腺癌和部位特异性癌症。在14.7年的中位随访期间，发生了2030例癌症病例。在人口统计学调整模型中，低eGFR和高ACR与癌症发病率相关（包括总体和总体非前列腺癌）。在调整了其他共同的危险因素后，这些关联减弱，仅与ACR（>= 103与5mg /g相比）和总体非前列腺癌存在显著关联。对于部位特异性癌症，只有高ACR与肺癌和尿路癌有显著关联。其中，ACR和肺癌之间的关联在几个敏感性分析中表现得最为明显。肾脏疾病指标，特别是高ACR，与癌症风险独立相关。ACR与肺癌之间的关联是独一无二的，值得未来的研究来探索潜在的机制。
Few studies have comprehensively investigated the association of 2 key kidney disease measures, estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR), with cancer incidence. In 8,935 participants at the baseline (1996-1998) from the Atherosclerosis Risk in Communities study, we quantified the associations of eGFR (based on creatinine and cystatin C) and ACR with cancer risk using Cox regression models adjusted for potential confounders. Due to changing guidelines for prostate cancer screening during the follow-up period, we investigated overall cancer, overall nonprostate cancer, and site-specific cancer. During a median follow-up of 14.7 years, 2,030 incident cancer cases occurred. In demographically adjusted models, low eGFR and high ACR were associated with cancer incidence (both overall and overall nonprostate cancer). These associations were attenuated after adjusting for other shared risk factors, with a significant association remaining only for ACR (>= 103 compared with 5 mg/g) and overall nonprostate cancer. For site-specific cancer, only high ACR showed a significant association with lung and urinary tract cancers. Of these, the association between ACR and lung cancer appeared most robust in several sensitivity analyses. Kidney disease measures, particularly high ACR, were independently associated with cancer risk. The association between ACR and lung cancer was uniquely robust, warranting future studies to explore potential mechanisms.