J Korean Med Sci.  2011 Jan;26(1):59-66. 10.3346/jkms.2011.26.1.59.

Effect of RAAS Inhibition on the Incidence of Cancer and Cancer Mortality in Patients with Glomerulonephritis

• Chin HJ
• Oh SW
• Goo HS
• Oh J
• Noh JW
• Cho JT
• Na KY
• Kim S
• Chae DW
• Members of the PREMIER Group

• KMID: 1777977
• DOI: http://doi.org/10.3346/jkms.2011.26.1.59

Abstract

Angiotensin II type 1 receptor blocker (ARB), which is frequently prescribed in patients with glomerulonephritis (GN), is suggested to increase the risk of cancer. We registered 3,288 patients with renal biopsy and analyzed the relationship between the use of renin-angiotensin-aldosterone system (RAAS) blockade and the incidence of cancer or cancer mortality. After renal biopsy, cancer developed in 33 patients with an incidence rate of 1.0% (95% of CI for incidence: 0.7%-1.3%). There was no difference in the cancer incidence among the groups according to the use of angiotensin-converting enzyme inhibitors (ACEI) or ARB: 1.2% in the None (23/1960), 0.7% in the ARB-only (5/748), 0.4% in the ACEI-only (1/247), and 1.2% in the ACEI-ARB (4/333) (P = 0.487) groups. The cancer mortality was 2.1%, 0.4%, 0.0%, and 0.3% in None, ACEI-only, ARB-only, and ACEI-ARB group, respectively (P < 0.001). The risk of cancer mortality in patients with ARB was only 0.124 (0.034-0.445) compared to that of non-users of ARB by Cox's hazard proportional analysis. In conclusion, prescription of ACEI or ARB in patients with GN does not increase cancer incidence and recipients of ARB show rather lower rates of all-cause mortality and cancer mortality.

Keyword

Glomerulonephritis; Neoplasms; Angiotensin II Type 1 Receptor Blockers

MeSH Terms

Adult
Aged
Angiotensin II Type 1 Receptor Blockers/*therapeutic use
Angiotensin-Converting Enzyme Inhibitors/*therapeutic use
Female
Follow-Up Studies
Glomerulonephritis/complications/diagnosis/*drug therapy
Humans
Incidence
Kidney/pathology
Male
Middle Aged
Neoplasms/complications/*epidemiology/mortality
Renin-Angiotensin System/*drug effects
Retrospective Studies
Risk Factors

Figure

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  Fig. 1 The incidence of cancer and cancer mortality after kidney biopsy. (A) Incidence of cancer, (B) Incidence of cancer mortality. There was no difference between None and other three groups in cancer incidence, also (P = 0.568). The cancer mortality in None group was higher than other 3 groups, too (P < 0.001).

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