Dipstick proteinuria and cancer incidence: a nationwide population-based study
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ORIGINAL ARTICLE
Dipstick proteinuria and cancer incidence: a nationwide population‑based study Shin Young Ahn1,2 · Yoon Jin Choi3 · Kyungdo Han4 · Gang Jee Ko1,2 · Young Joo Kwon1,2 · Yong‑Gyu Park4 Received: 10 November 2019 / Accepted: 11 April 2020 © Italian Society of Nephrology 2020
Abstract Background The association between proteinuria and malignancy has been frequently reported, but the issue is matter of controversy. Thus, in order to shed light on the association, we evaluated proteinuria as a risk factor for malignancy using the dataset from the Korean National Health Insurance System (NHIS). Methods The subjects had undergone a medical examination in 2009 (index year) among the entire Korean adult population. From a pool of 10,505,818 participants, we excluded subjects who were younger than 19 years (15,327), had a previous diagnosis of cancer (152,095), had missing data for at least one variable (544,508), and were diagnosed with cancer within 1 year from the index year (79,501). Proteinuria was examined by a single dipstick urinalysis. Results A total of 9,714,387 subjects were included in this study and tracked until December 31, 2017. The participants were divided into three groups; no (95.2%), trace (2.3%), and overt (2.5%) proteinuria. Over the duration of this study, we observed that overt proteinuria was associated with an increased risk of cancer development (all cancers) (adjusted HR 1.154, 95% CI 1.134–1.173) and the long-term risk of cancer incidence increased proportionally according to the changes in proteinuria over a four-year period. Limitations Our study population consisted of Korean adults. Therefore, the results of this study may not be generalized to other ethnicities. Conclusions We found a significant relationship between proteinuria and the risk of overall and site-specific cancer development. Further studies are needed to find an explanation of these findings. Keywords Dipstick proteinuria · Cancer incidence · Risk · Nationwide database
Introduction
Shin Young Ahn and Yoon Jin Choi contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40620-020-00740-1) contains supplementary material, which is available to authorized users.
Proteinuria is a main marker of chronic kidney disease (CKD) [1–3] and an independent risk factor for cardiovascular and non-cardiovascular mortality [4, 5]. Even trace proteinuria is associated with an increased risks of mortality and morbidity in the general population as well as in specific patient groups [6–8]. Given that a major cause of non-cardiovascular mortality is malignancy, the
* Shin Young Ahn [email protected]
2
Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
* Yong‑Gyu Park [email protected]
3
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
4
Department of Biostatistics, College of Medicine, The Catholic University of Korea, 222, Ban
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