Age, sex, certain drugs up risk of advanced colorectal neoplasia in CKD

The risk of developing advanced colorectal neoplasia in patients with chronic kidney disease (CKD) is strongly associated with older age, male sex, and exposure to erythropoiesis-stimulating agents and azathioprine, a study has found.

A total of 1,706 patients with CKD stages 3-5, including those treated with maintenance dialysis or transplantation, underwent screening for colorectal neoplasia using a faecal immunochemical test (FIT). Researchers identified advanced colorectal neoplasia through a two-step verification process with colonoscopy following positive FIT and 2-year clinical follow-up.

Of the patients, 791 had CKD stages 3–5 and were not receiving maintenance dialysis, 418 were receiving dialysis, and 497 had received a kidney transplant. Advanced colorectal neoplasia was detected in 117 (6.9 percent) patients overall, including 54 with CKD stages 3–5 not receiving dialysis, 34 receiving dialysis, and 29 transplant recipients; nine of these cases were colorectal cancers.

On multivariable logistic regression analysis, factors significantly associated with advanced colorectal neoplasia included older age (per year: odds ratio [OR], 1.05, 95 percent confidence interval [CI], 1.03–1.07; p<0.001), male sex (OR, 2.27, 95 percent CI, 1.45–3.54; p<0.001), azathioprine use (OR, 2.99, 95 percent CI, 1.40–6.37; p=0.005), and erythropoiesis-stimulating agent use (OR, 1.92, 95 percent CI, 1.22–3.03; p=0.005).

Sensitivity analysis using grouped LASSO logistic regression revealed similar results.

The study was limited by unmeasured confounding factors.