A novel risk factor for malignancy: Albuminuria

Abstract

Cancer is the second leading cause of death among the adult population following cardiovascular diseases. Prevention and earlier diagnosis are among the cornerstones in the management of malignancies. Albuminuria is a diagnostic criterion for chronic kidney disease and has been associated with multiple conditions including cardiovascular diseases and systemic inflammation while the association between albuminuria and malignancy has been inadequately addressed. Large-scale observational studies with long follow-up periods demonstrate a statistically significant association between albuminuria and overall malignancy incidence, especially urothelial malignancy incidence. However, the underlying pathophysiology linking these two entities is not a straightforward causal relationship but most likely a multidirectional relationship including a causal link. In this narrative review, we evaluate the clinical studies investigating the association between albuminuria and malignancy along with potential underlying mechanisms linking them. We also summarize data on the impact of treatment modalities prescribed for albuminuria and/or proteinuria on the prevention or prognosis of malignancies. • Albuminuria has been associated with a higher risk of overall malignancies. However, the molecular mechanisms involved, and the clinical practice consequences are poorly understood. • Recent guidance from Scientific Societies has expanded the target population for albuminuria screening program. • Additionally, recent clinical trials have expanded the range of drugs that lower albuminuria for renin-angiotensin system blockers to also include mineralocorticoid receptor antagonists, SGLT2 inhibitors and GLP-1 receptor agonists. This has resulted in changes in the clinical guidelines on the treatment of albuminuria in diabetic and non-diabetic individuals. • Implementation of recent clinical guidance documents on the screening and treatment of albuminuria will provide a unique opportunity to more thoroughly assess the association of albuminuria with the risk of malignancy and explore the impact of albuminuria-lowering drugs on this risk. • The design and implementation of prospective studies, ideally pragmatic clinical trials are the optimal way to assess the association of albuminuria with malignancy and the impact of albuminuria-lowering drugs. • Absent this, the post-hoc analyses of prospectively collected information from healthcare and mortality databases will offer additional research opportunities. • This information may be eventually used to develop clinical guidance documents on the screening and treatment of albuminuria in individuals at high risk of malignancy. © 2023 European Federation of Internal Medicine