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Not only is there a relationship between cancer and kidney disease, but it’s also an important one.

“There are many ways that cancer and kidney disease are connected,” says Pooja Amarapurkar, MD, director, Onco-Nephrology, UPMC Kidney Disease Center.

The following are some of the ways that research has linked these two deadly diseases:

• Patients with kidney disease are at higher risk of cancer.
• Patients with cancer have a higher risk of kidney disease. This is because cancer treatments and the cancer itself can damage the kidneys.

Specialists known as onco-nephrologists can help treat patients with cancer-related kidney problems.

Learn more about the link between cancer and kidney disease and how to manage both.

Cancer Risk in People with Kidney Disease

Research shows that cancer and kidney disease may lead to worse outcomes. Cancer is the second-leading cause of death in people with chronic kidney disease. That’s according to the journal Nephrology Dialysis Transplantation.

Among their many jobs, your kidneys clear out waste products and other toxins from your body. But if you have kidney disease, your kidneys can’t do this as well.

“When that happens, over time, there may be a buildup of some toxins leading to a pro-inflammatory state, which creates a conducive environment for cancer growth,” Dr. Amarapurkar explains.

In 2022, the American Journal of Kidney Diseases published a study. The results of it found that a higher risk of cancer in people with kidney disease was “substantial.” It also found this was true for people who had kidney transplants.

The risk of cancer-related death was also higher in people with kidney disease.

Another study in Nephrology Dialysis Transplantation met with similar results. It found that people who had kidney transplants were two to three times more at risk of cancer. It also found that patients on dialysis are at a greater risk of cancer.

Other research has linked many different cancers with kidney disease. That’s according to The Lancet. Your risk for different cancers can depend on many factors. These can include gender, whether you’re on dialysis, what medications you’re taking, and whether you’ve had a transplant.

Because of this, Dr. Amarapurkar believes it’s important for nephrologists to look for and recognize warning signs.

Kidney Disease Risk in Cancer Patients

Patients with cancer may have a risk of developing kidney disease. Chemotherapy drugs and other cancer treatments can damage the kidneys.

The kidneys play a major role in eliminating drugs from the body. As a result, they process large amounts of chemotherapy drugs. Sometimes, those drugs are “nephrotoxic,” or toxic to the kidneys.

Many common chemotherapy agents can damage the kidneys. One example of this is checkpoint inhibitors.

“The checkpoint inhibitors activate the immune system to make it fight the cancer,” Dr. Amarapurkar says. “But at times, in doing so, they can attack some organs and cause damage. The kidneys are innocent bystanders.

“These are called immune-related adverse events. However, these therapies may be necessary for survival from cancer — even if they damage the kidneys.”

In 2020, The Lancet published a report on the link between cancer and kidney disease. According to the report, cancer can increase the risk of kidney injury and disease.

Certain cancers, like lymphomas, can invade the kidneys. Others, like myeloma, produce certain proteins that can harm the kidneys.

Last but not least, certain cancers can grow large enough to block the path of urine flow. This can lead to kidney problems.

Kidney disease can affect a patient’s chance of cancer survival. Having kidney disease poses drug dosing challenges. It’s also a comorbidity that burdens the body.

Dr. Amarapurkar says onco-nephrologists help oncologists navigate this complex landscape. They also optimize therapy for patients with cancer and kidney disease.

The Role of Onco-Nephrologists in Care

Because of the link between cancer and kidney disease, onco-nephrologists can play an important role in cancer and kidney care.

Onco-nephrologists are doctors who specialize in evaluating, managing, and treating kidney-related cancer complications. Oncologists can consult them if a cancer patient develops kidney problems. They can also consult on care for kidney disease patients who develop cancer.

“It’s a team-based approach with the oncologist to treat patients with cancer and kidney disease,” Dr. Amarapurkar says.

“We have an established relationship with the oncologists. We work with them closely. We even have multidisciplinary discussions about treatment plans, outcomes, and strategies to help deliver the best care possible.

“One of the main roles of the onco-nephrologist is to be comfortable with all the established and newer therapies,” Dr. Amarapurkar says. “Because of the ever-evolving nature of cancer treatment, it is challenging for a nephrologist to keep at pace with the advances.

“Being an onco-nephrologist, we see these patients all the time. This keeps us up to speed and also makes us comfortable in managing patients with cancer and kidney disease.”

At the UPMC Kidney Disease Center, our onco-nephrologists have deep knowledge of the relationship between cancer and kidney disease. We work with experts from UPMC Hillman Cancer Center to provide multidisciplinary cancer and kidney care. To learn more about the services we provide, visit our website.