American Journal of Kidney Diseases

Reduced Estimated GFR and Cancer Mortality

Published:September 03, 2013DOI:


      Chronic kidney disease is associated with an increased risk of cancer, but whether reduced kidney function also leads to increased cancer mortality is uncertain. The aim of our study was to assess the independent effects of reduced kidney function on the risk of cancer deaths.

      Study Design

      Prospective population-based cohort study.

      Setting & Participants

      Participants of the Blue Mountains Eye Study (n = 4,077; aged 49-97 years).


      Estimated glomerular filtration rate (eGFR).


      Overall and site-specific cancer mortality.


      During a median follow-up of 12.8 (IQR, 8.6-15.8) years, 370 cancer deaths were observed in our study cohort. For every 10-mL/min/1.73 m2 reduction in eGFR, there was an increase in cancer-specific mortality of 18% in the fully adjusted model (P < 0.001). Compared with participants with eGFR ≥ 60 mL/min/1.73 m2, the adjusted HR for cancer-specific mortality for those with eGFR < 60 mL/min/1.73 m2 was 1.27 (95% CI, 1.00-1.60; P = 0.05). This excess cancer mortality varied with site, with the greatest risk for breast and urinary tract cancer deaths (adjusted HRs of 1.99 [95% CI, 1.05-3.85; P = 0.01] and 2.54 [95% CI, 1.02-6.44; P = 0.04], respectively).


      Residual confounding, such as from unmeasured socioeconomic factors and the potential effects of erythropoiesis-stimulating agents on cancer deaths, may have occurred.


      eGFR < 60 mL/min/1.73 m2 appears to be a significant risk factor for death from cancer. These effects appear to be site specific, with breast and urinary tract cancers incurring the greatest risk of death among those with reduced kidney function.

      Index Words

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        • Coresh J.
        • Astor B.C.
        • Greene T.
        • Eknoyan G.
        • Levey A.S.
        Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey.
        Am J Kidney Dis. 2003; 41: 1-12
        • Coresh J.
        • Selvin E.
        • Stevens L.A.
        • et al.
        Prevalence of chronic kidney disease in the United States.
        JAMA. 2007; 298: 2038-2047
        • Dalrymple L.S.
        • Katz R.
        • Kestenbaum B.
        • et al.
        Chronic kidney disease and the risk of end-stage renal disease versus death.
        J Gen Intern Med. 2011; 26: 379-385
        • Wong G.
        • Hayen A.
        • Chapman J.R.
        • et al.
        Association of CKD and cancer risk in older people.
        J Am Soc Nephrol. 2009; 20: 1341-1350
        • Jorgensen L.
        • Heuch I.
        • Jenssen T.
        • Jacobsen B.K.
        Association of albuminuria and cancer incidence.
        J Am Soc Nephrol. 2008; 19: 992-998
      1. Australian and New Zealand Dialysis and Transplant Registry. The 30th Annual Report. 2-1-2007. Accessed August 19, 2013.

        • Weng P.H.
        • Hung K.Y.
        • Huang H.L.
        • Chen J.H.
        • Sung P.K.
        • Huang K.C.
        Cancer-specific mortality in chronic kidney disease: longitudinal follow-up of a large cohort.
        Clin J Am Soc Nephrol. 2011; 6: 1121-1128
        • Mitchell P.
        • Smith W.
        • Attebo K.
        • Wang J.J.
        Prevalence of age-related maculopathy in Australia. The Blue Mountains Eye Study.
        Ophthalmology. 1995; 102: 1450-1460
        • Skali H.
        • Uno H.
        • Levey A.S.
        • Inker L.A.
        • Pfeffer M.A.
        • Solomon S.D.
        Prognostic assessment of estimated glomerular filtration rate by the new Chronic Kidney Disease Epidemiology Collaboration equation in comparison with the Modification of Diet in Renal Disease Study equation.
        Am Heart J. 2011; 162: 548-554
        • Levey A.S.
        • Stevens L.A.
        • Schmid C.H.
        • et al.
        A new equation to estimate glomerular filtration rate.
        Ann Intern Med. 2009; 150 ([erratum in Ann Intern Med. 2011;155(6):408]): 604-612
        • Zhang X.
        • Zhang M.J.
        SAS macros for estimation of direct adjusted cumulative incidence curves under proportional subdistribution hazards models.
        Comput Methods Programs Biomed. 2011; 101: 87-93
        • Fried L.F.
        • Katz R.
        • Sarnak M.J.
        • et al.
        Kidney function as a predictor of noncardiovascular mortality.
        J Am Soc Nephrol. 2005; 16: 3728-3735
        • Chung S.D.
        • Huang K.H.
        • Lai M.K.
        • et al.
        CKD as a risk factor for bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma.
        Am J Kidney Dis. 2007; 50: 743-753
        • Lemy A.
        • Wissing K.M.
        • Rorive S.
        • et al.
        Late onset of bladder urothelial carcinoma after kidney transplantation for end-stage aristolochic acid nephropathy: a case series with 15-year follow-up.
        Am J Kidney Dis. 2008; 51: 471-477
        • Vajdic C.M.
        • McDonald S.P.
        • McCredie M.R.
        • et al.
        Cancer incidence before and after kidney transplantation.
        JAMA. 2006; 296: 2823-2831
        • LeBrun C.J.
        • Diehl L.F.
        • Abbott K.C.
        • Welch P.G.
        • Yuan C.M.
        Life expectancy benefits of cancer screening in the end-stage renal disease population.
        Am J Kidney Dis. 2000; 35: 237-243
        • Williams N.C.
        • Tong A.
        • Howard K.
        • Chapman J.R.
        • Craig J.C.
        • Wong G.
        Knowledge, beliefs and attitudes of kidney transplant recipients regarding their risk of cancer.
        Nephrology. 2012; 17: 300-306
        • Reuter S.
        • Gupta S.C.
        • Chaturvedi M.M.
        • Aggarwal B.B.
        Oxidative stress, inflammation, and cancer: how are they linked?.
        Free Radic Biol Med. 2010; 49: 1603-1616
        • Lawless M.W.
        • O'Byrne K.J.
        • Gray S.G.
        Targeting oxidative stress in cancer.
        Expert Opin Ther Targets. 2010; 14: 1225-1245
        • Lawless M.W.
        • O'Byrne K.J.
        • Gray S.G.
        Oxidative stress induced lung cancer and COPD: opportunities for epigenetic therapy.
        J Cell Mol Med. 2009; 13: 2800-2821
        • Inamoto H.
        • Ozaki R.
        • Matsuzaki T.
        • Wakui M.
        • Saruta T.
        • Osawa A.
        Incidence and mortality patterns of malignancy and factors affecting the risk of malignancy in dialysis patients.
        Nephron. 1991; 59: 611-617
        • Kiberd B.A.
        • Rose C.
        • Gill J.S.
        Cancer mortality in kidney transplantation.
        Am J Transplant. 2009; 9: 1868-1875