Risk of Colorectal Cancer Higher in Patients With Chronic Kidney Disease

Regardless of the stage of cancer, patients with chronic kidney disease (CKD) had a higher risk of developing colorectal cancer (CRC), according to a meta-analysis published in the Arab Journal of Urology.

CKD has increased in prevalence in the United States in the past couple of decades. CRC is the third most common form of cancer worldwide. CRC has a better prognosis when it is detected and treated early. Patients with CKD are more prone to cancer and would benefit from knowing their risk of CRC to adequately screen for it. The current systematic review aimed to evaluate the relationship between CKD and CRC in patients and explore the association between them both.

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Studies were searched for in PubMed, Embase, Scopus, and Cochrane Library. Inclusion criteria consisted of population-based cohort studies that focused on the risk of CRC in CKD, studies that included standard incidence ratio (SIR) and 1 complication, included mortality information, and were published in English. Studies that sampled from patients who did not have CKD, the SIR could not be extracted or estimated, could not be extracted from the database, or had a lack of available data were excluded. Measuring the incidence of CRC and prevalence among the different CKDs was the primary outcome of the analysis.

There were 50 studies published between 1997 and 2022 that were included in the review. The studies were from 19 different countries, including Japan, Australia/New Zealand, Finland, Hong-Kong, Canada, Ireland, Egypt, Italy, Korea, Malaysia, Poland, Portugal, Netherlands, Sweden, Spain, Taiwan, the United Kingdom, and the United States. Retrospective studies made up 46 of the studies whereas the remaining studies were cross-sectional, case-control, and matched cohort. Median age of the participants was 43 to 64 years across 16 studies and the mean (SD) age was 38.9 to 62.5 years in the 27 studies that reported it.

The pooled SIR was 1.33 (95% CI, 1.30-1.36) in the 14 studies that reported on patients with CRC who had CKD. This was a significantly increased risk of CRC. Incidence rate of CRC ranged from 0.75 (95% CI, 0.47-1.13) to 3.94 (95% CI, 2.10-6.73). Age was not found to be correlated with the risk of colorectal renal disease. There was also no small study effect found in the meta-analysis.

There were some limitations to this study. The meta-analysis only included observational studies. There was a lack of information about mortality in the studies included, which led to those details being left out. Patients were not separated into groups based on the stages and severity of CKD because of a lack of data. Sample size variated between the different studies which caused some heterogeneity.

The researchers concluded that patients with CKD are a population at high risk of developing CRC. Future studies should include larger sample sizes to confirm the findings of this meta-analysis.

Reference

Al-Qudimat AR, Al Darwish MB, Altahtamouni SB, et al. Chronic kidney diseases and the risk of colorectal cancer: a systematic review and meta-analysis. Arab J Urol. Published online June 20, 2023. doi:10.1080/2090598x.2023.2225315