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Dipstick proteinuria and cancer incidence: a nationwide population-based study

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Abstract

Background

The association between proteinuria and malignancy has been frequently reported, but the issue is matter of controversy. Thus, in order to shed light on the association, we evaluated proteinuria as a risk factor for malignancy using the dataset from the Korean National Health Insurance System (NHIS).

Methods

The subjects had undergone a medical examination in 2009 (index year) among the entire Korean adult population. From a pool of 10,505,818 participants, we excluded subjects who were younger than 19 years (15,327), had a previous diagnosis of cancer (152,095), had missing data for at least one variable (544,508), and were diagnosed with cancer within 1 year from the index year (79,501). Proteinuria was examined by a single dipstick urinalysis.

Results

A total of 9,714,387 subjects were included in this study and tracked until December 31, 2017. The participants were divided into three groups; no (95.2%), trace (2.3%), and overt (2.5%) proteinuria. Over the duration of this study, we observed that overt proteinuria was associated with an increased risk of cancer development (all cancers) (adjusted HR 1.154, 95% CI 1.134–1.173) and the long-term risk of cancer incidence increased proportionally according to the changes in proteinuria over a four-year period.

Limitations

Our study population consisted of Korean adults. Therefore, the results of this study may not be generalized to other ethnicities.

Conclusions

We found a significant relationship between proteinuria and the risk of overall and site-specific cancer development. Further studies are needed to find an explanation of these findings.

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Funding

The authors received no specific funding for this work.

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Author notes

  1. Shin Young Ahn and Yoon Jin Choi contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea

    Shin Young Ahn, Gang Jee Ko & Young Joo Kwon

  2. Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea

    Shin Young Ahn, Gang Jee Ko & Young Joo Kwon

  3. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea

    Yoon Jin Choi

  4. Department of Biostatistics, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Kyungdo Han & Yong-Gyu Park

Authors
  1. Shin Young Ahn
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  2. Yoon Jin Choi
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  3. Kyungdo Han
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  4. Gang Jee Ko
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Contributions

SYA and YJC contributed equally to this work. SYA and YGP have full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. YJC, KH, and GJK participated in research design. KH, GJK, and YJK participated in analysis and interpretation of data. YJC and KH participated in data collection.

Corresponding authors

Correspondence to Shin Young Ahn or Yong-Gyu Park.

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Conflict of interest

The authors have declared no conflicts of interest.

Ethical statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval was waived in this study by the Institutional Review Board (IRB) of Korea University Medical Center Guro Hospital (Seoul, Korea) (#IRB No. K2019-0642-001). Informed consent was not obtained because patient records and information were anonymized and de-identified prior to analysis. This study was also approved by National Health Insurance Service (NHIS-2019-1-413).

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Ahn, S.Y., Choi, Y.J., Han, K. et al. Dipstick proteinuria and cancer incidence: a nationwide population-based study. J Nephrol 33, 1067–1077 (2020). https://doi.org/10.1007/s40620-020-00740-1

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  • DOI: https://doi.org/10.1007/s40620-020-00740-1

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