TY - JOUR
T1 - Factors Associated With Advanced Colorectal Neoplasia in Patients With CKD
AU - Au, Eric H.
AU - Wong, Germaine
AU - Howard, Kirsten
AU - Chapman, Jeremy R.
AU - Castells, Antoni
AU - Roger, Simon D.
AU - Bourke, Michael J.
AU - Macaskill, Petra
AU - Turner, Robin
AU - Lim, Wai H.
AU - Lok, Charmaine E.
AU - Diekmann, Fritz
AU - Cross, Nicholas
AU - Sen, Shaundeep
AU - Allen, Richard D.
AU - Chadban, Steven J.
AU - Pollock, Carol A.
AU - Tong, Allison
AU - Teixeira-Pinto, Armando
AU - Yang, Jean Y.
AU - Kieu, Anh
AU - James, Laura
AU - Craig, Jonathan C.
N1 - Funding Information:
Eric H. Au, MBBS, Germaine Wong MBBS, PhD, Kirsten Howard, PhD, Jeremy R. Chapman, MD, Antoni Castells, MD, PhD, Simon D. Roger, MD, Michael J. Bourke, MBBS, PhD, Petra Macaskill, PhD, Robin Turner, PhD, Wai H. Lim, MBBS, PhD, Charmaine E. Lok, MD, MSc, Fritz Diekmann, MD, PhD, Nicholas Cross, MBChB, PhD, Shaundeep Sen, MBBS, PhD, Richard D. Allen, MBBS, FRACS, PhD, Steven J. Chadban, MBBS, PhD, Carol A. Pollock, MBBS, PhD, Allison Tong, PhD, Armando Teixeira-Pinto, PhD, Jean Y. Yang, PhD, Anh Kieu, MPH, Laura James, MPH, and Jonathan C. Craig, MBChB, PhD. Research idea and study design: EHA, GW, JCC; data acquisition: all authors; data analysis: EHA; data interpretation: all authors. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. The DETECT study is funded by the Australian National Health and Medical Research Council (NHMRC) Screening and Test Evaluation Program Grant (APP 633003) and Better Evidence And Translation in CKD Program Grant (APP 1092579). EHA is supported by a NHMRC Postgraduate Scholarship and Royal Australasian College of Physicians Jacquot NHMRC Award for Excellence. The funders had no role in the study design, analysis, reporting, or decision to submit the manuscript for publication. The authors declare that they have no relevant financial interests. We would like to thank all the participants of the DETECT Study for generously participating in this research. We would also like to thank the clinicians, nurses, and clinical research staff who have kindly assisted us by collecting information from participants for this study. We thank Dr Gabrielle Williams for data management of the original data set and some follow-up of patients. We would like to extend our deepest gratitude to Dr Richard Hope for his unfailing support throughout the study. Without his dedication and perseverance over many years, the DETECT study would not have been possible. He is sadly missed by all members of the DETECT team, his patients, and fellow researchers. Received January 4, 2021. Evaluated by 3 external peer reviewers and a statistician, with editorial input from an Acting Editor-in-Chief (Editorial Board Member Morgan E. Grams, MD, PhD, MHS). Accepted in revised form July 16, 2021. The involvement of an Acting Editor-in-Chief to handle the peer-review and decision-making processes was to comply with AJKD's procedures for potential conflicts of interest for editors, described in the Information for Authors & Journal Policies.
Funding Information:
The DETECT study is funded by the Australian National Health and Medical Research Council (NHMRC) Screening and Test Evaluation Program Grant (APP 633003) and Better Evidence And Translation in CKD Program Grant (APP 1092579). EHA is supported by a NHMRC Postgraduate Scholarship and Royal Australasian College of Physicians Jacquot NHMRC Award for Excellence. The funders had no role in the study design, analysis, reporting, or decision to submit the manuscript for publication.
Publisher Copyright:
© 2021 National Kidney Foundation, Inc.
PY - 2022/4
Y1 - 2022/4
N2 - Rationale & Objective: The risk of developing colorectal cancer in patients with chronic kidney disease (CKD) is twice that of the general population, but the factors associated with colorectal cancer are poorly understood. The aim of this study was to identify factors associated with advanced colorectal neoplasia in patients with CKD. Study Design: Prospective cohort study. Setting & Participants: Patients with CKD stages 3-5, including those treated with maintenance dialysis or transplantation across 11 sites in Australia, New Zealand, Canada, and Spain, were screened for colorectal neoplasia using a fecal immunochemical test (FIT) as part of the Detecting Bowel Cancer in CKD (DETECT) Study. Exposure: Baseline characteristics for patients at the time of study enrollment were ascertained, including duration of CKD, comorbidities, and medications. Outcome: Advanced colorectal neoplasia was identified through a 2-step verification process with colonoscopy following positive FIT and 2-year clinical follow-up for all patients. Analytical Approach: Potential factors associated with advanced colorectal neoplasia were explored using multivariable logistic regression. Sensitivity analyses were performed using grouped LASSO (least absolute shrinkage and selection operator) logistic regression. Results: Among 1,706 patients who received FIT-based screening—791 with CKD stages 3-5 not receiving kidney replacement therapy (KRT), 418 receiving dialysis, and 497 patients with a functioning kidney transplant—117 patients (6.9%) were detected to have advanced colorectal neoplasia (54 with CKD stages 3-5 without KRT, 34 receiving dialysis, and 29 transplant recipients), including 9 colorectal cancers. The factors found to be associated with advanced colorectal neoplasia included older age (OR per year older, 1.05 [95% CI, 1.03-1.07], P < 0.001), male sex (OR, 2.27 [95% CI, 1.45-3.54], P < 0.001), azathioprine use (OR, 2.99 [95% CI, 1.40-6.37], P = 0.005), and erythropoiesis-stimulating agent use (OR, 1.92 [95% CI, 1.22-3.03], P = 0.005). Grouped LASSO logistic regression revealed similar associations between these factors and advanced colorectal neoplasia. Limitations: Unmeasured confounding factors. Conclusions: Older age, male sex, erythropoiesis-stimulating agents, and azathioprine were found to be significantly associated with advanced colorectal neoplasia in patients with CKD.
AB - Rationale & Objective: The risk of developing colorectal cancer in patients with chronic kidney disease (CKD) is twice that of the general population, but the factors associated with colorectal cancer are poorly understood. The aim of this study was to identify factors associated with advanced colorectal neoplasia in patients with CKD. Study Design: Prospective cohort study. Setting & Participants: Patients with CKD stages 3-5, including those treated with maintenance dialysis or transplantation across 11 sites in Australia, New Zealand, Canada, and Spain, were screened for colorectal neoplasia using a fecal immunochemical test (FIT) as part of the Detecting Bowel Cancer in CKD (DETECT) Study. Exposure: Baseline characteristics for patients at the time of study enrollment were ascertained, including duration of CKD, comorbidities, and medications. Outcome: Advanced colorectal neoplasia was identified through a 2-step verification process with colonoscopy following positive FIT and 2-year clinical follow-up for all patients. Analytical Approach: Potential factors associated with advanced colorectal neoplasia were explored using multivariable logistic regression. Sensitivity analyses were performed using grouped LASSO (least absolute shrinkage and selection operator) logistic regression. Results: Among 1,706 patients who received FIT-based screening—791 with CKD stages 3-5 not receiving kidney replacement therapy (KRT), 418 receiving dialysis, and 497 patients with a functioning kidney transplant—117 patients (6.9%) were detected to have advanced colorectal neoplasia (54 with CKD stages 3-5 without KRT, 34 receiving dialysis, and 29 transplant recipients), including 9 colorectal cancers. The factors found to be associated with advanced colorectal neoplasia included older age (OR per year older, 1.05 [95% CI, 1.03-1.07], P < 0.001), male sex (OR, 2.27 [95% CI, 1.45-3.54], P < 0.001), azathioprine use (OR, 2.99 [95% CI, 1.40-6.37], P = 0.005), and erythropoiesis-stimulating agent use (OR, 1.92 [95% CI, 1.22-3.03], P = 0.005). Grouped LASSO logistic regression revealed similar associations between these factors and advanced colorectal neoplasia. Limitations: Unmeasured confounding factors. Conclusions: Older age, male sex, erythropoiesis-stimulating agents, and azathioprine were found to be significantly associated with advanced colorectal neoplasia in patients with CKD.
KW - Azathioprine
KW - bowel cancer
KW - chronic kidney disease (CKD)
KW - colonoscopy
KW - colorectal cancer
KW - dialysis
KW - end-stage renal disease (ESRD)
KW - epidemiology
KW - fecal immunochemical test (FIT)
KW - risk factors
KW - transplant recipient
UR - https://www.scopus.com/pages/publications/85116941446
U2 - 10.1053/j.ajkd.2021.07.011
DO - 10.1053/j.ajkd.2021.07.011
M3 - Article
C2 - 34461168
AN - SCOPUS:85116941446
SN - 0272-6386
VL - 79
SP - 549
EP - 560
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 4
ER -
SDG 3 Good Health and Well-being