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Advanced kidney disease and kidney cancer risk

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 21, 2021.

Chronic kidney disease (CKD) happens when the kidneys can’t filter blood in order to produce urine the way they're supposed to. It may be caused by conditions such as diabetes and high blood pressure, and sometimes by the use of chemotherapy drugs. The U.S. Centers for Disease Control and Prevention estimates that 15 percent of the U.S. population have chronic kidney disease and most are undiagnosed.

The later stages of chronic kidney disease are called advanced kidney disease. There are five stages of kidney disease, with stage 1 being early-stage and stage 5 being kidney failure. Treatment for very advanced kidney disease includes a kidney transplant or dialysis, which is when an external machine filters the blood because the kidneys can’t do their job anymore. Once kidney disease is treated with either a transplant or dialysis, it’s referred to as end-stage renal disease (ESRD).

What do the kidneys do?

The kidneys are two bean-shaped organs just below the rib cage, located on either side of the spine. They have a few essential jobs, though it’s possible to live with only one kidney.

The kidneys:

  • Remove waste products, excess water and salt from your blood
  • Produce urine
  • Send urine down the ureters and into the bladder
  • Make a hormone called renin that helps control blood pressure
  • Make a hormone called erythropoietin that helps red blood cell production in bone marrow

When your kidneys aren’t functioning as they should, they aren’t able to effectively do any of the above tasks. Since the kidneys have an impact on the body in several ways, kidney disease can have a complex relationship with a number of different conditions, including cancer.

How are advanced kidney disease and kidney cancer linked?

There’s a link between advanced kidney disease and cancer in each direction. People with advanced kidney disease have a higher risk of kidney cancer, and people with kidney cancer have a higher risk of developing kidney disease. This link is made even more complex by treatments for each condition.

Cancer risk and advanced kidney disease

Patients with advanced chronic kidney disease, in particular those on dialysis or who’ve had a kidney transplant, are more likely to develop renal cell carcinoma (RCC), the most common form of kidney cancer.

Having advanced kidney disease also makes the patient more likely to develop other types of cancer, not just kidney cancer. Some studies have suggested kidney disease is also linked to an increased risk of:

There may also be an increased risk of thyroid cancer, skin cancer and liver cancer.

The risk of developing cancer seems highest for people who’ve had a kidney transplant due to their advanced kidney disease. Several studies have found the risk of developing cancer is significantly increased after having a kidney transplant.

Kidney disease drugs and cancer risk

Some drugs used in chronic kidney disease treatment, or the treatment of complications of kidney disease, have been found to cause cancer or affect survival. For example, one such drug, cyclophosphamide, has been linked to bladder cancer.

Erythropoiesis-stimulating agents, or ESAs, which are commonly used to treat CKD-related anemia, have been linked to shorter survival in people with CKD and cancer, but how the treatment affects survival isn’t well understood.

The news about ESAs isn’t all bad, however. Some studies have shown they reduced the need for blood transfusions in people with CKD and cancer. But they also may speed up cancer progression, so researchers are still studying the connection.

There’s a link between advanced kidney disease and kidney cancer, but even earlier-stage kidney disease may increase the risk of developing kidney cancer.

Kidney disease risk among people with kidney cancer

When people who have renal cell carcinoma also develop kidney disease, their prognosis becomes worse. People who have RCC and kidney disease may experience fatal complications from their kidney disease.

Chemotherapy drugs and kidney disease

If you have chronic kidney disease, even early-stage kidney disease, and are diagnosed with cancer, your treatment options may be limited for a few reasons:

You may not be well enough to withstand aggressive cancer treatment. Kidney disease may be affecting your body so much that your care team may be concerned about putting it through the additional stressors of chemotherapy.

It may be difficult to figure out the ideal dosing for your treatment. Because kidney disease affects how your body processes and filters certain substances, it may be challenging for your care team to determine what the appropriate dose of chemotherapy drugs is for you. As many anticancer drugs are processed in the body, they’re eliminated through the kidneys. If you have chronic kidney disease, your body may absorb more or less of the drug than is expected, possibly leading to toxic levels in some cases.

There may be drug interactions to avoid. If you’re on medications to treat chronic kidney disease, another chronic condition or a complication of kidney disease, that medication may interact with chemotherapy or other anticancer drugs.

On the other hand, studies have shown that kidney disease may develop in someone who has cancer due to chemotherapy treatment. Chemotherapy drugs, while tough on cancer cells, may be challenging for the healthy cells in your body to process, too. Many chemotherapy drugs currently in use are toxic to the kidneys, though they’ve been found to be successful cancer treatments. These drugs may have a detrimental effect on kidney function, especially in advanced-stage cancers.

How does dialysis affect cancer risk?

Dialysis is a treatment for advanced kidney disease that filters your blood since your kidneys no longer can. There are two main types of dialysis.

Hemodialysis: In this type of dialysis, a steady stream of your blood flows to a machine that filters it before returning the blood back to you. The machine removes wastes in your blood, helping you feel better. It may be done at a dialysis center or at home.

Peritoneal dialysis: This type of dialysis uses the lining of your abdomen, also called the peritoneum, to filter your blood while it’s inside your body. You can do this type of dialysis at home, but it typically requires a surgery prior to starting, and you’ll need to use a dialysis solution to conduct the process at home.

Dialysis doesn’t cure chronic kidney disease, but it may help you feel better as it filters waste out of your blood. People who have been on dialysis for a long time sometimes develop cancerous cysts on their kidneys. Typically, they’re detected and removed before they spread. Studies have also shown a link between dialysis and an increased risk of cancers of the urinary tract and digestive tract, as well as endocrine cancers such as thyroid cancer.

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