Risk of cancer in pre-dialysis chronic kidney disease: A nationwide population-based study with a matched control group
Risk of cancer in pre-dialysis chronic kidney disease: A nationwide population-based study with a matched control group
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DOI：
10.23876/j.krcp.18.0131
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发表时间：
2019-03-01
影响因子：
3
通讯作者：
Kim, Dong Ki
中科院分区：
文献类型：
--
作者：
Park, Sehoon;Lee, Soojin;Kim, Dong Ki
背景：透析前慢性肾病（CKD）的癌症风险和流行病学值得在大规模队列中进行进一步研究。方法：我们利用韩国国家健康保险数据库进行了一项全国范围的人口研究。我们筛选了 2009 年至 2016 年间接受过 2 次全国健康检查的 18,936,885 名个体的记录。根据血清肌酐和试纸蛋白尿结果识别透析前 CKD。先前存在癌症病史、接受肾脏替代治疗或短暂性 CKD 的个体被排除在外。纳入了一个没有肾功能损害证据且年龄、性别、低收入状况和吸烟史相匹配的对照组。使用多变量 Cox 回归模型对理赔数据库中确定的癌症风险进行了调查，该模型包括匹配变量和其他不匹配的临床特征作为协变量。结果：总共纳入了 471,758 名透析前 CKD 患者和相同数量的匹配对照者。透析前 CKD 和所有 CKD 阶段的泌尿系统（调整后风险比 [HR]，1.97；95% 置信区间 [95% CI]，1.82-2.13）和造血系统（调整后 HR，1.53；95% CI，1.38-1.68）恶性肿瘤风险增加。然而，透析前 CKD 组患消化道癌症的风险较低（调整后 HR，0.89；95% CI，0.87-0.92）。消化系统、呼吸系统、甲状腺和前列腺恶性肿瘤的风险与 CKD 分期呈非线性相关，1 期或 4/5 期 CKD 未经透析的风险相对较低。结论：与对照组相比，透析前 CKD 的癌症风险有所不同，癌症风险与 CKD 分期之间的关联因癌症类型而异。
Background: Cancer risk and epidemiology in pre-dialysis chronic kidney disease (CKD) warrant further investigation in a large-scale cohort.Methods: We performed a nationwide population-based study using the national health insurance database of Korea. We screened records from 18,936,885 individuals who received a national health examination >= 2 times from 2009 to 2016. Pre-dialysis CKD was identified based on serum creatinine and dipstick albuminuria results. Individuals with preexisting cancer history, renal replacement therapy, or transient CKD were excluded. A control group without evidence of kidney function impairment and matched for age, sex, low-income status, and smoking history was included. Risk of cancers, as identified in the claims database, was investigated using a multivariable Cox regression model including matched variables and other unmatched clinical characteristics as covariates.Results: A total of 471,758 people with pre-dialysis CKD and the same number of matched controls were included. Urinary (adjusted hazard ratio [HR], 1.97; 95% confidence interval [95% CI], 1.82-2.13) and hematopoietic (adjusted HR, 1.53; 95% CI, 1.38-1.68) malignancy risk was increased in pre-dialysis CKD and all CKD stages. However, the risk of digestive cancer was lower in the pre-dialysis CKD group (adjusted HR, 0.89; 95% CI, 0.87-0.92). The risk of digestive, respiratory, thyroid, and prostate malignancy demonstrated a non-linear association with CKD stage, with stage 1 or stage 4/5 CKD without dialysis demonstrating relatively lower risk.Conclusion: Cancer risk varied in pre-dialysis CKD compared to controls, and the association between cancer risk and CKD stage varied depending on the cancer type.