Cancer Screening in End-Stage Kidney Disease

Global epidemiology of kidney cancer

Kidney cancer (KC) is a disease with a rising worldwide incidence estimated at 400 000 new cases annually, and a worldwide mortality rate approaching 175 000 deaths per year. Current projections suggest incidence continuing to increase over the next decade, emphasizing the urgency of addressing this significant global health trend. Despite the overall increases in incidence and mortality, striking social disparities are evident. Low- and middle-income countries bear a disproportionate burden of the disease, with higher mortality rates and later-stage diagnoses, underscoring the critical role of socioeconomic factors in disease prevalence and outcomes. The major risk factors for KC, including smoking, obesity, hypertension and occupational exposure to harmful substances, must be taken into account. Importantly, these risk factors also often contribute to kidney injury, a condition that the review identifies as a significant, yet under-recognized, precursor to KC. Finally, the indispensable role of nephrologists is underscored in managing this complex disease landscape. Nephrologists are at the forefront of detecting and managing kidney injuries, and their role in mitigating the risk of KC is becoming increasingly apparent. Through this comprehensive analysis, we aim to facilitate a more nuanced understanding of KC's epidemiology and determinants providing valuable insights for researchers, clinicians and policymakers alike.

Association of estimated glomerular filtration rate with prostate cancer risk in a cross-ethnic population: a Mendelian randomization study

OBJECTIVE

To investigate whether a causal relationship exists between the estimated glomerular filtration rate (EGFR) and the occurrence of prostate cancer in East Asian and European populations and to determine if genetic factors influence the association between the EGFR and prostate cancer risk.

METHODS

In this Mendelian randomization study, the existence of a causal relationship between the EGFR and prostate cancer occurrence was assessed using five analytical techniques, including Mendelian randomization-Egger regression (MR-Egger), calculation of the weighted median estimator (WME), the maximum likelihood ratio method, the linear median weighting method and the random-effects inverse-variance weighting (IVW) method.

RESULTS

In the IVW model, no causal relationship was observed between the EGFR and prostate cancer in either the East Asian or European populations.

CONCLUSIONS

After excluding confounding factors and reverse causal associations using two-sample Mendelian randomization, unbiased estimates were obtained, and there was no causal relationship between prostate cancer and the EGFR in the East Asian or European populations. Therefore, for patients with suspected prostate cancer, it is considered unnecessary to improve the detection of glomerular filtration rate, which will effectively reduce the economic burden of patients.

The potential association between influenza vaccination and lower incidence of renal cell carcinoma

It is well-established that kidney cancer or renal cell carcinoma (RCC) occurs more commonly in chronic kidney disease (CKD) than in the general population, although the underlying mechanisms are incompletely understood. Beyond hereditary RCC syndromes; smoking, obesity and hypertension are widely known risk factors for RCC, irrespective of CKD. Kidney-specific factors such as episodes of acute kidney injury, nephrolithiasis and cyst formation have also been shown to be associated with RCC development. One potential and less explored factor is the role of viruses in the development of kidney cancer. In this issue of Clinical Kidney Journal, Lin et al. raise the interesting hypothesis that influenza vaccination may be associated with lower incidence of RCC in adults with CKD. We discuss potential mechanisms underlying this interesting observation in the context of immune dysregulation in CKD.

Investigation of XPD, miR-145 and miR-770 expression in patients with end-stage renal disease

BACKGROUND

The effective maintenance of genome integrity and fidelity is vital for the normal function of our tissues and organs, and the prevention of diseases. DNA repair pathways maintain genome stability, and the adequacy of genes acting in these pathways is essential for disease suppression and direct treatment responses. Chronic kidney disease is characterized by high levels of genomic damage. In this study, we examined the expression levels of the xeroderma pigmentosum group D (XPD) gene, which plays a role in the nucleotide excision repair (NER) repair mechanism, and the expression levels of miR-145 and miR-770 genes, which play a role in the regulation of the expression of the XPD gene, in hemodialysis patients with (n = 42) and without malignancy (n = 9) in pre- and post-dialysis conditions. We also evaluated these values with the clinical findings of the patients.

METHODS & RESULTS

Gene expression analysis was performed by real-time polymerase chain reaction (qRT-PCR). Compared to the individuals with normal kidney function (2.06 ± 0.32), the XPD gene expression was lower in the pre-dialysis condition both in hemodialysis patients without cancer (1.24 ± 0.18; p = 0.02) and in hemodialysis patients with cancer (0.82 ± 0.114; p = 0.001). On the other hand, we found that miR-145 and miR-770 expression levels were high in both groups. We also found that expression levels were affected by dialysis processes. A statistically significant positive correlation was found between miR-145 and mir770 expression levels in the pre-dialysis group of patients with (r=-0.988. p = 0.0001) and without (r=-0.934. p = 0.0001) malignancy.

CONCLUSIONS

Studies on DNA damage repair in the kidney will help develop strategies to protect kidney function against kidney diseases.