LONG-TERM RISK OF KIDNEY DISEASE IN NEW CANCER PATIENTS: A POPULATION-BASED COHORT STUDY

 

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https://storage.unitedwebnetwork.com/files/1099/8285ede2a73e755fa1a98b39a0ad2e93.pdf
LONG-TERM RISK OF KIDNEY DISEASE IN NEW CANCER PATIENTS: A POPULATION-BASED COHORT STUDY

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Sumaiya
Ahmed
Sumaiya Ahmed sahme116@uottawa.ca University of Ottawa Nephrology Ottawa Canada *
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Cancer survival has improved, shifting attention to long term treatment harms and survivorship. Kidney disease after cancer diagnosis can alter chemotherapy choices, interrupt targeted therapies, increase hospitalization, and worsen survival. Evidence from large representative cohorts quantifying absolute and relative risks across common cancers is limited. We aimed to estimate the risk of chronic kidney disease, kidney failure, and acute kidney injury after a new diagnosis of solid tumor cancer.

We conducted a population based cohort study using linked provincial health administrative databases at ICES, Ontario, Canada. We identified adults with a first diagnosis of breast, prostate, lung, or colorectal cancer and followed them from cancer diagnosis. Exclusions included prior kidney transplant or maintenance dialysis. Primary outcomes were incident chronic kidney disease (using repeated estimated glomerular filtration rate thresholds and sustained decline definitions) and kidney failure (dialysis or transplant). Secondary outcomes included hospitalization with acute kidney injury and all cause mortality. Covariates encompassed age, sex, baseline kidney function and albuminuria where available, comorbidities, socioeconomic indicators, and cancer site; exposures to nephrotoxic or kidney related anticancer treatments (for example cisplatin, vascular endothelial growth factor pathway inhibitors, and immune checkpoint inhibitors) were modeled as time varying. We used cause specific Cox models with death as a competing risk and Fine–Gray subdistribution models to estimate adjusted hazard ratios and absolute risk at prespecified time horizons, with stratified analyses by cancer site and baseline kidney function.

Cohort creation and deterministic–probabilistic linkages are complete. Data quality checks and covariate construction are finalized, and outcome algorithms have been implemented. Primary analyses are in progress and will estimate adjusted hazard ratios and absolute risk differences for chronic kidney disease, kidney failure, and acute kidney injury overall and by cancer site and treatment exposure. We will also report cumulative incidence functions accounting for the competing risk of death and key sensitivity analyses (including alternate definitions of sustained decline in estimated glomerular filtration rate and treatment exposure lags).

This large, real world study will quantify the burden and timing of kidney outcomes after common solid tumor cancers and across contemporary anticancer treatments. The results are expected to inform risk stratification, survivorship care planning, and safer use of nephrotoxic therapies in oncology practice.

Kewords