Obese chronic kidney disease diabetic’s patients: Malignant tumours

Editor

Patients with chronic kidney disease (CKD) have a high incidence of malignant tumours. Purpose of the study: Prospective observational study of factors present at initial evaluation of stage 3 CKD patients proceeding from external consultations after two years of follow-up. Exclusion criteria: Under 40 or mayor 79 years old, anaemia, previous heart or hepatic failure, valvular or isquemic cardiopathy, arrhythmias, clinical arterial peripheral disease or immunosuppressive treatment. Inclusion criteria: All the incidental patients who wish to participated between January, 2012 and January, 2014. The study was approved by the Committee of Ethics of Clinical Investigation.

There were studied 126 stage 3 CKD patients (77 stages 3A, 49 stages 3B) (72 men, 54 women) (33 diabetics). 7 patients had a malignant tumor and at the initial evaluation, they showed: older age (70,29 + 5,02 vs. 60,66 + 9,61 years old, p= 0,01), higher BMI (33,75 + 5,14 vs. 29,46 + 4,92 Kg/m2, p= 0,027), higher levels of troponins (0,096 + 0,15 vs. 0,011 + 0,01 ng/ml, p= 0,0001) and beta-2 microglobulins (4,16 + 1,93 vs. 2,92 + 0,85 pg/ml, p= 0,001). Also, they were more often treated with insulin (42, 9% vs. 8, 4%, p= 0,004) or an ACE-inhibitor (57, 1% vs. 23,5%, p=0,04). There were no differences related to sex, smoking, NT-proBNP, glomerular filtration rate, proteinuria or other pharmacological treatments. 7 cases of malignant tumours were: 1 multiple myeloma, 2 squamous cell carcinomas, 2 adenocarcinomas of the prostate, one hepatocarcinoma and 1 neoplasm of larynx.

Conclusion

In spite of the low number of patients, it seems that stage 3 CKD patients without anaemia or previous clinical cardiovascular event who had a malignant tumour after two years of follow up, were more often older obese diabetic patients treated with insulin or an ACE-inhibitor at initial evaluation. According to data analyzed, and as usual, obesity is related to malignant tumours and in the future, it would be interested to study the adequate treatment for older obese chronic kidney disease diabetic´s patients.