Yonsei Med J.  2020 Jun;61(6):506-514. 10.3349/ymj.2020.61.6.506.

The Combined Impact of Chronic Kidney Disease and Diabetes on the Risk of Colorectal Cancer Depends on Sex: A Nationwide Population-Based Study

Affiliations
  • 1Ewha Institute of Convergence Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
  • 2Ewha Institute of Research Institute for Human Health Information, Ewha Womans University Mokdong Hospital, Seoul, Korea
  • 3Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, Korea
  • 4Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
  • 5Tissue Injury Defense Research Center, Ewha Womans University, Seoul, Korea

Abstract

Purpose
Although both chronic kidney disease (CKD) and diabetes mellitus (DM) are considered factors increasing the risk of colorectal cancer (CRC), their impact on CRC is not fully understood. This study was aimed to investigate the impact of CKD, DM, or both diseases on the risk of CRC and to evaluate sex differences therein.
Materials and Methods
Using data from the National Health Insurance Service–Health Examination Cohort in Korea, we conducted a 1:2 matched case-control study. The disease groups consisted of CKD-/DM+ (n=17700), CKD+/DM- (n=22643), and CKD+/DM+ groups (n=8506). After 1:2 matching by age, sex, and health examination year and month, the healthy control group consisted of 97698 individuals.
Results
Multivariate Cox regression analysis showed that the CKD-/DM+, CKD+/DM-, and CKD+/DM+ groups were independently associated with an increased incidence of CRC, compared with controls [hazard ratio (HR), 1.34, 1.31, and 1.63, respectively; all p<0.001]. Compared to the controls, adjusted HRs for the cumulative incidence of CRC in the CKD-/DM+, CKD+/DM-, and CKD+/DM+ groups were, respectively, 1.32, 1.26, and 1.43 in male and 1.38, 1.39, and 2.00 in female. The HR for CRC incidence was significantly higher for the CKD+/DM+ group than for the CKD-/DM+ or CKD+/DM- group in female; however, this significant difference was not observed in male.
Conclusion
In female, having both CKD and DM significantly increases the risk of CRC, compared with having CKD or DM alone. This study suggests a significant difference in the effect of CKD or DM on the risk of CRC according to sex.

Keyword

Chronic kidney disease; diabetes mellitus; colorectal cancer; incidence; sex
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