An increase in albuminuria is associated with a higher incidence of malignancies

Li Luo; Lyanne M Kieneker; Yuanhang Yang; Roemer J Janse; Alessandro Bosi; Rudolf A de Boer; Priya Vart; Juan-Jesus Carrero; Ron T Gansevoort

doi:10.1093/ckj/sfae009

An increase in albuminuria is associated with a higher incidence of malignancies

Clin Kidney J. 2024 Jan 12;17(3):sfae009. doi: 10.1093/ckj/sfae009. eCollection 2024 Mar.

Authors

Li Luo¹, Lyanne M Kieneker¹, Yuanhang Yang², Roemer J Janse^{2

3}, Alessandro Bosi², Rudolf A de Boer⁴, Priya Vart⁵, Juan-Jesus Carrero^{2

6}, Ron T Gansevoort¹

Affiliations

¹ Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
² Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
³ Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
⁴ Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, The Netherlands.
⁵ Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁶ Division of Nephrology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.

Abstract

Background: A single albuminuria measurement is reported to be an independent predictor of cancer risk. Whether change in albuminuria is also independently associated with cancer is not known.

Methods: We included 64 303 subjects of the Stockholm CREAtinine Measurements (SCREAM) project without a history of cancer and with at least two urine albumin-creatinine ratio (ACR) tests up to 2 years apart. Albuminuria changes were quantified by the fold-change in ACR over 2 years, and stratified into the absence of clinically elevated albuminuria (i.e. never), albuminuria that remained constant, and albuminuria that increased or decreased. The primary outcome was overall cancer incidence. Secondary outcomes were site-specific cancer incidences.

Results: During a median follow-up of 3.7 (interquartile range 3.6-3.7) years, 5126 subjects developed de novo cancer. After multivariable adjustment including baseline estimated glomerular filtration rate and baseline ACR, subjects with increasing ACR over 2 years had a 19% (hazard ratio 1.19; 95% confidence interval 1.08-1.31) higher risk of overall cancer compared with those who never had clinically elevated ACR. No association with cancer risk was seen in the groups with decreasing or constant ACR. Regarding site-specific cancer risks, subjects with increasing ACR or constant ACR had a higher risk of developing urinary tract and lung cancer. No other associations between 2-year ACR changes and site-specific cancers were found.

Conclusions: Increases in albuminuria over a 2-year period are associated with a higher risk of developing overall, urinary tract and lung cancer, independent of baseline kidney function and albuminuria. These data add important weight to the link that exists between albuminuria and cancer incidence.

Keywords: albuminuria; cancer; chronic kidney disease.