Abstract LB083: Characterizing colon and prostate cancers with comorbid chronic kidney disease in NHANES
Authors: Behring Michael , Nelson Dawna , Vazin Tina , Alagan Ram , Aladuwaka Seela , Mishra Manoj , Shafi Tariq , Gutierrez Orlando , Manne Upender 
Published: July 2021

Abstract
In the US, the prevalence of chronic kidney disease (CKD) is estimated at 30 million, or approximately 15% of the population. Compared to Caucasians (CA), African Americans (AAs) have a higher prevalence of CKD, and faster decline in kidney function. Relationships between low socio-economic status (SES), area-level social disadvantages, and CKD are well documented. In cancer patients, CKD impedes overall survival, treatment, and surgical outcomes. Given the link between kidney disease preceding cancer, as well as the higher risk of mortality for cancer patients with CKD, the goals of this research were to identify the tumor types most associated with CKD prevalence and to elucidate the modifying effects of age, race, gender, and lifestyle/environmental measures on these relationships. Using the National Health and Nutrition Examination Survey (NHANES), we generated cross-sectional associations between CKD and various cancer types for the years of 2007-2018. After exclusion for age under 18 years, non-AA or non-CA race, or incomplete information for exposure (CKD) or outcome (cancer), a nationally representative, weighted sample of ~25,000 subjects was included in the analysis. CKD was defined as estimated glomerular function (eGFR) &lt;60 ml/min/1.73 m2. Self-reported measures of ever having any type of cancer and type of cancer were used for tumor variables. CKD was present in 15% of all NHANES subjects, and 21% of those with CKD reported having any cancer versus 12% of those without CKD. In a cancer-only analysis, overrepresented tumor types in CKD vs. non-CKD patients were prostate (23% vs. 6%) and colon (7% vs. 4%). Cases of colon cancer were significantly higher for CKD patients of all races, with the largest CKD-related difference for female AAs (28% in CKD vs. 7% in non-CKD). For both races, prostate cancer had higher CKD comorbidity, strongest for male AAs. While eGFR normally decreases with age, AAs had low eGFR in younger cases (50-60years), for both prostate and colon cancers, notably in female AAs with colon cancer. Body mass index (BMI) was higher for those with CKD (29.4) versus non-CKD (28.9). In a gender/race stratified analysis, AA women with colon cancer who were obese (BMI 30+) had 1.66 times the odds of also having CKD relative to all other BMI categories. Men with colon cancer also showed increased odds of CKD in obese versus all other BMI categories (AA 1.98, CA 1.21). There was no effect of BMI on prostate cancer. Overall, CKD is a more frequent in cancer patients than for cancer-free patients even when accounting for age. This relationship is modified by tumor type, race, and gender. Prostate and colon cancers have strong associations with CKD which are independent of age in AAs. Obesity is linked to CKD-comorbid colon cancers for AAs and males. These findings identify high-risk subgroups for colon cancer and suggest dietary/metabolic/environmental etiology and intervention strategies.
Citation Format: Michael Behring, Dawna Nelson, Tina Vazin, Ram Alagan, Seela Aladuwaka, Manoj Mishra, Tariq Shafi, Orlando Gutierrez, Upender Manne. Characterizing colon and prostate cancers with comorbid chronic kidney disease in NHANES [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB083.