Association between chronic kidney disease and mortality in stage IV cancer
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ORIGINAL ARTICLE
Association between chronic kidney disease and mortality in stage IV cancer Taisuke Ishii1,2 · Takuya Fujimaru1 · Eriko Nakano2 · Osamu Takahashi3 · Masaaki Nakayama1 · Teruo Yamauchi2 · Yasuhiro Komatsu1,4 Received: 20 November 2019 / Accepted: 26 May 2020 © Japan Society of Clinical Oncology 2020
Abstract Background Chronic kidney disease (CKD) is known to be associated with cancer mortality. However, no study has considered the well-known cancer prognostic factors, ECOG Performance Status (PS) and cancer treatment, as confounding factors. We assessed the independent relationship between CKD and cancer death in stage IV cancer patients. Methods In this retrospective observational study, we included stage IV cancer patients diagnosed from 2009 to 2014 in a single center. We collected baseline clinical and laboratory variables, and cancer-specific variables, and assessed the presence of CKD. Our primary outcome was all-cause mortality. The secondary outcome was cancer-specific mortality and site-specific cancer mortality. Results Among 961 eligible stage IV cancer patients (median age 69 years, 51.8% male), 150 patients had CKD. During follow-up (median 9.8 months), 638 patients died, of whom 526 patients died from cancer. After adjusting for prognostic variables, including ECOG PS and cancer treatment, all-cause mortality and cancer-specific mortality were significantly higher in CKD patients than in non-CKD patients (HR 1.41, 95% CI 1.13–1.77 and HR 1.43, 95% CI 1.12–1.83, respectively). In patients with breast and kidney and urinary tract cancers, CKD was associated with a significantly increased risk of death (HR 7.01, 95% CI 1.47–33.4 and HR 3.33, 95% CI 1.42–7.78, respectively). Conclusions CKD at the time of stage IV cancer diagnosis was associated with all-cause mortality and cancer-specific mortality. Moreover, the association between CKD and cancer-specific death was site specific for breast cancer and kidney and urinary tract cancer. Keywords Cancer · Mortality · Chronic kidney disease · ECOG performance status · Treatment
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10147-020-01715-9) contains supplementary material, which is available to authorized users. * Takuya Fujimaru [email protected]
1
Department of Nephrology, St. Luke’s International Hospital, 9‑1 Akashi‑cho, Chuo‑ku, Tokyo 104‑8560, Japan
Taisuke Ishii [email protected]
2
Department of Medical Oncology, St. Luke’s International Hospital, 9‑1 Akashi‑cho, Chuo‑ku, Tokyo 104‑8560, Japan
Eriko Nakano [email protected]
3
Graduate School of Public Health, St. Luke’s International University, OMURA Susumu and Mieko Memorial, St. Luke’s Center for Clinical Academia 5th Floor, 3‑6 Tsukiji, Chuo‑ku, Tokyo 104‑0045, Japan
4
Department of Healthcare Quality and Safety, Gunma University Graduate School of Medicine, 3‑39‑22 Shouwa‑cho, Maebashi‑shi, Gunma 371‑8511, Japan
Osamu Takahashi [email protected] Masaaki Nakayama nakayama@lu
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