Kidney Res Clin Pract  
Risk of cancer in pre-dialysis chronic kidney disease: A nationwide population-based study with a matched control group
Sehoon Park1,2, Soojin Lee2,3, Yaerim Kim2, Yeonhee Lee2,3, Min Woo Kang2,3, Kyungdo Han4, Seoung Seok Han2,5, Hajeong Lee2,5, Jung Pyo Lee3,5,6, Kwon Wook Joo2,3,5, Chun Soo Lim3,5,6, Yon Su Kim1,2,5, Dong Ki Kim2,3,5
1Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
2Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
3Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
4Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
5Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
6Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
Correspondence to: Dong Ki Kim
Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. E-mail: dkkim73@gmail.com ORCID: https://orcid.org/0000-0002-5195-7852
Received: November 5, 2018; Revised: December 1, 2018; Accepted: December 23, 2018; Published online: March 7, 2019.
© The Korean Society of Nephrology. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
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.
Keywords: Cancer, Chronic kidney disease, Comorbidity, Epidemiology, Neoplasms


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