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. Prospective cohort study. 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. Baseline characteristics for patients at the time of study enrollment were ascertained, including duration of CKD, comorbidities, and medications. 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. 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. 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], <0.001), male sex (OR, 2.27 [95% CI, 1.45-3.54], <0.001), azathioprine use (OR, 2.99 [95% CI, 1.40-6.37], =0.005), and erythropoiesis-stimulating agent use (OR, 1.92 [95% CI, 1.22-3.03], =0.005). Grouped LASSO logistic regression revealed similar associations between these factors and advanced colorectal neoplasia. Unmeasured confounding factors. Older age, male sex, erythropoiesis-stimulating agents, and azathioprine were found to be significantly associated with advanced colorectal neoplasia in patients with CKD.

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CKD 患者晚期结直肠肿瘤的相关因素


慢性肾病（CKD）患者患结直肠癌的风险是普通人群的两倍，但与结直肠癌相关的因素却知之甚少。本研究的目的是确定与 CKD 患者晚期结直肠肿瘤相关的因素。前瞻性队列研究。作为检测肠癌的一部分，使用粪便免疫化学测试 (FIT) 对 CKD 3-5 期患者（包括在澳大利亚、新西兰、加拿大和西班牙 11 个地点接受维持性透析或移植治疗的患者）进行结直肠肿瘤筛查从事 CKD（检测）研究。确定了研究入组时患者的基线特征，包括 CKD 持续时间、合并症和药物治疗。对所有患者进行阳性 FIT 和 2 年临床随访后，通过结肠镜检查的两步验证过程确定了晚期结直肠肿瘤。使用多变量逻辑回归探讨与晚期结直肠肿瘤相关的潜在因素。使用分组 LASSO（最小绝对收缩和选择算子）逻辑回归进行敏感性分析。在接受基于 FIT 筛查的 1,706 名患者中，其中 791 名 CKD 3-5 期患者未接受肾脏替代治疗 (KRT)，418 名接受透析，497 名进行功能性肾移植的患者，其中 117 名患者 (6.9%) 被发现患有晚期疾病结直肠肿瘤（54 例患有 CKD 3-5 期但未进行 KRT，34 例接受透析，29 例接受移植），其中包括 9 例结直肠癌。发现与晚期结直肠肿瘤相关的因素包括年龄较大（OR，每增加一岁，1.05 [95% CI，1.03-1.07]，<0.001）、男性（OR，2.27 [95% CI，1.45-3.54]、 <0。001）、硫唑嘌呤的使用（OR，2.99 [95% CI，1.40-6.37]，=0.005）和红细胞生成刺激剂的使用（OR，1.92 [95% CI，1.22-3.03]，=0.005）。分组 LASSO 逻辑回归揭示了这些因素与晚期结直肠肿瘤之间的相似关联。无法衡量的混杂因素。研究发现，年龄较大、男性、红细胞生成刺激剂和硫唑嘌呤与 CKD 患者的晚期结直肠肿瘤显着相关。