在医疗保险服务收费人群中癌症与急性肾损伤的关系

IF 3.4 Q1 UROLOGY & NEPHROLOGY

Kidney Medicine Pub Date : 2025-07-16 DOI:10.1016/j.xkme.2025.101069

Yoshihisa Miyamoto, Linda J. Andes, Alain K. Koyama, Fang Xu, Meda E. Pavkov

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引用次数: 0

摘要

原因与目的急性肾损伤（acute kidney injury， AKI）是癌症的常见并发症，其发生与多种因素有关。我们的目的是评估医疗保险受益人中各种癌症与AKI事件之间的当代关联。研究设计：回顾性观察性研究。设定&参与者年龄≥66岁的医疗保险按服务收费受益人。暴露更新癌症诊断。结果：AKI的发生率。分析方法：随访开始于癌症诊断或2014年12月31日，对照组为AKI、死亡、癌症，或5年结束，以先发生者为准。通过病因特异性Cox模型和Fine-Gray竞争风险模型，调整年龄、性别、种族和民族以及合并症，评估癌症和AKI之间的总体和部位特异性关联。结果：我们确定了482016名新诊断为癌症的受益人和相同数量的匹配对照。癌症组和对照组的中位随访时间分别为4.1年（四分位数范围[IQR]， 1.0-5.0年）和4.8年（四分位数范围[IQR]， 1.7-5.0年）。肾盂癌和输尿管癌的5年AKI风险最高，为32.8%(95%可信区间[CI]， 30.7%-34.8%)；多发性骨髓瘤32.6% (95% CI, 31.7%-33.4%)；肾癌28.9% （95% CI, 28.2%-29.5%）。与对照组相比，多发性骨髓瘤AKI的多变量调整亚分布风险比明显更高，而死亡率高的癌症（如胰腺癌、肺癌和支气管癌、肝癌、胆囊癌和胆道癌或胃癌）的AKI风险比明显更低。局限性：使用国际疾病分类代码识别癌症和AKI可能存在的错误分类，未测量变量造成的残留混淆，缺乏癌症分期和组织学信息，未考虑包括药物在内的癌症治疗。结论：不同癌症类型的AKI风险不同。与对照组相比，多发性骨髓瘤的AKI风险最高。急性肾损伤（AKI）是肿瘤生长、治疗和其他健康状况导致的癌症患者常见并发症。本研究分析了2014年新诊断为癌症的66岁及以上医疗保险受益人中癌症类型与AKI风险之间的关系。肾盂/输尿管癌（32.8%）、多发性骨髓瘤（32.6%）和肾癌（28.9%）的5年AKI风险最高。在调整合并症条件后，多发性骨髓瘤的AKI风险明显高于对照组。这些发现强调了不同癌症类型的AKI风险差异。

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Association Between Cancer and Incident Acute Kidney Injury Among Medicare Fee-for-Service Population

Rationale & Objective

Acute kidney injury (AKI) is a frequent complication of cancer due to multiple factors. Our aim was to assess contemporary associations between various cancers and incident AKI among Medicare beneficiaries.

Study Design

A retrospective observational study.

Setting & Participants

Medicare fee-for-service beneficiaries aged ≥66 years.

Exposure

New cancer diagnosis.

Outcomes

Incidence of AKI.

Analytical Approach

Follow-up started at cancer diagnosis or on December 31, 2014, for controls and ended at the date of AKI, death, cancer in the control group, or at 5 years, whichever occurred first. Overall and site-specific associations between cancer and AKI were assessed by cause-specific Cox models and Fine-Gray competing risk models, adjusting for age, sex, race and ethnicity, and comorbid conditions.

Results

We identified 482,016 beneficiaries with newly diagnosed cancer and the same number of matched controls. The median follow-up time was 4.1 years (interquartile range [IQR], 1.0-5.0 years) and 4.8 (IQR, 1.7-5.0 years), respectively, for cancer cases and controls. The highest 5-year risk of AKI was observed in cancer of the renal pelvis and ureter 32.8% (95% confidence interval [CI], 30.7%-34.8%); multiple myeloma 32.6% (95% CI, 31.7%-33.4%); and kidney cancer 28.9% (95% CI, 28.2%-29.5%). The multivariable-adjusted subdistribution hazard ratio for AKI was significantly higher for multiple myeloma compared with controls and was significantly lower for cancers with high mortality, such as pancreatic, lung and bronchial, liver, gallbladder and biliary, or stomach cancer.

Limitations

Potential misclassification from using International Classification of Diseases codes to identify cancer and AKI, residual confounding from unmeasured variables, lack of information on cancer stage and histology, and not accounting for cancer treatment including medication.

Conclusions

Risks of AKI vary across cancer types. Multiple myeloma had the highest significant risk of AKI compared with controls.

Plain-Language Summary

Acute kidney injury (AKI) is a common complication in patients with cancer due to tumor growth, treatments, and other health conditions. This study analyzed the association between cancer types and AKI risk among Medicare beneficiaries aged 66 years or older with new cancer diagnoses in 2014. Cancers of the renal pelvis/ureter (32.8%), multiple myeloma (32.6%), and kidney cancer (28.9%) had the highest 5-year AKI risks. Multiple myeloma showed a significantly higher AKI risk compared with controls after adjustment for comorbid conditions. These findings highlight variations in AKI risk across cancer types.

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