Table 2.

Suggested future directions to clarify the observed relationship between non-dialysis CKD and risk of cancer incidence and death

Patient factors	Assess whether modifiable lifestyle factors (e.g. weight loss, increased exercise and smoking cessation) reduce the risk of cancer in CKD.
Disease factors	Exploration of causal pathways between CKD and cancer, and the impact of shared risks including behavioural, lifestyle, disease and genetic factors (e.g., using Mendelian randomization).
	Identify whether patients with CKD present with more invasive cancer stage.
	Clarify the role of cystatin C in tumorigenesis and whether this may be a mechanism by which patients with CKD (thus increased circulating cystatin C) experience a higher incidence of cancer or more rapidly progressive disease.
Investigation and treatment factors	Widespread assessment of the uptake and utility of cancer screening amongst people with CKD, including dialysis and transplantation, the association with outcome and cost-effectiveness.
	Assess whether inclusion of eGFR or albuminuria into cancer risk prediction tools would facilitate earlier diagnosis, treatment and improve outcome.
	Assess whether there are differences in treatment response to SACT in people with CKD, including those on dialysis or with a kidney transplant.
	Explore whether renal adverse abbreviate the dose or duration of SACT in people with CKD.