127 The Epidemiology of Colorectal Cancer in Chronic Kidney Disease in the U.S.: A Population-Based Study (2014–2019)

Abstract

INTRODUCTION: Recent studies have shown an association between chronic kidney disease (CKD) and increased risk of developing cancer. Limited data is available regarding the prevalence of colorectal cancer (CRC) in patients with CKD. Using a large database, we sought to evaluate this potential risk association. METHODS: We reviewed data from a commercial database (Explorys Inc, Cleveland, OH, USA) that provided electronic health records from 26 major integrated US healthcare systems. Based on the Systematized Nomenclature of Medicine—Clinical Terms (SNOMED-CT), we identified a cohort of patients with a diagnosis of CRC without CKD, from 2014–2019, which served as a control group. Similarly, we identified a cohort of patients with SNOMED-CT diagnosis of first ever with CRC after at least one year of CKD diagnosis. We performed analyses to describe distributions based on age, gender, and race, as well as to evaluate underlying risk factors. RESULTS: Of the 36,770,450 individuals in the database (2014–2019), 1,359,450 had the diagnosis of CKD (3.69%) and 1,438,540 (3.91%) had the diagnosis of CRC. Amongst CKD patients, 73520 (5.4%) individuals had a first ever diagnosis of CRC after at least one year of being diagnosed with CKD. When compared to individuals without a history of CKD, CKD patients were more likely to develop CRC [OR: 1.76; 95% CI 1.74–1.77, P < 0.0001]. Individuals with CKD and CRC were more likely to be males [OR: 1.21; 95% CI 1.19 to 1.23, P < 0.0001], elderly (age >65) [OR: 3.62; 95% CI 3.55 to 3.69, P < 0.0001], and African American [OR: 2.34; 95% CI 2.30 to 2.38, P < 0.0001]. They were also more likely to be smokers [OR: 1.38; 95% CI 1.36 to 1.41, P < 0.0001], diabetic [OR: 5.04; 95% CI = 4.96 to 5.11, P < 0.0001], and with history of IBD [OR: 1.32; 95% CI 1.27 to 1.38, P < 0.0001], obesity [OR: 2.55; 95% CI 2.49 to 2.56, P < 0.0001] and exposure to radiation [OR: 1.14; 95% CI 1.09 to 1.19, P < 0.0001] when compared to individuals without CKD (Figure 1). CONCLUSION: This population-based cohort study indicated a possible increase of 19.2% in the prevalence of CRC in patients with CKD compared to those without CKD. This may be due to either an increased utilization of the health care system by CKD patients or another unknown confounding factor or even a true association. Given the limitations of our study due to the risk of confounding bias in the database and lack of endoscopic and histological data, this association needs to be confirmed in further studies.