We evaluated the temporal association between kidney function, assessed by estimated glomerular filtration rate (eGFR), and the risk of incident renal cell carcinoma (RCC). We also evaluated if eGFR if can improve RCC risk discrimination beyond established risk factors.
We analyzed the UK Biobank cohort, including 463,178 participants of whom 1447 were diagnosed with RCC during 5,696,963 person-years of follow-up. We evaluated the temporal association between eGFR and RCC risk using flexible parametric survival models, adjusted for C-reactive protein (CRP) and RCC risk factors. eGFR was calculated from creatinine and cystatin C levels.
Lower eGFR, an indication of poor kidney function, was associated with higher RCC risk when measured up to five years prior to diagnosis. The RCC hazard ratio (HR) per standard deviation decrease in eGFR when measured one year before diagnosis was 1.26 (95% Confidence Interval [95% CI]: 1.16-1.37), and 1.11 (95% CI: 1.05-1.17) when measured five years before diagnosis. Adding eGFR to the RCC risk model provided a small improvement in risk discrimination 1 year before diagnosis with an AUC of 0.73 (95% CI: 0.67-0.84) compared to the published model (0.69, 95% CI: 0.63-0.79).
This study demonstrated that kidney function markers are associated with RCC risk, but the nature of these associations are consistent with reversed causality. Markers of kidney function provided limited improvements in RCC risk discrimination beyond established risk factors.
eGFR may be of potential use to identify individuals in the extremes of the risk distribution.
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2023 Sep 05 [Epub ahead of print]
Karine Alcala, Hana Zahed, Ricardo Cortez Cardoso Penha, Nicolas Alcala, Hilary A Robbins, Karl Smith-Byrne, Richard M Martin, David C Muller, Paul Brennan, Mattias Johansson
International Agency For Research On Cancer, Lyon, France., International Agency For Research On Cancer, France., International Agency for Research on Cancer/World Health Organization (IARC/WHO), Lyon, France., Genetic Epidemiology Branch, Section of Genetic, International Agency for Research on Cancer (IARC-WHO), Lyon, France., University of Bristol, Any Other White Background, United Kingdom., Imperial College London, London, United Kingdom.