2967-LB: Renal Function Markers and Pancreatic Cancer Risk in Patients with Type 2 Diabetes: Findings from the Tianjin Diabetes and Health Cohort Study

Introduction and Objective: Patients with type 2 diabetes (T2D) have an elevated risk of pancreatic cancer (PC), but practical strategies to identify high-risk individuals are limited. We aimed to determine whether estimated glomerular filtration rate (eGFR) and serum creatinine were associated with incident PC in T2D. Methods: We conducted a retrospective cohort study using the Tianjin Diabetes and Health Cohort, including patients aged at least 20 years with T2D and no prior PC. The primary exposure was baseline eGFR, categorized as at least 90, 60-89, and less than 60 mL/min/1.73 m²; serum creatinine tertiles were analyzed as a secondary exposure. The outcome was incident PC identified by ICD-10 code C25. Propensity score-based inverse probability weighting and Cox regression estimated hazard ratios (HRs) and 95% CIs. Restricted cubic splines (RCS) assessed dose-response relationships, and linear mixed-effects models compared longitudinal trajectories between PC and non-PC groups. Results: Among 249,255 patients with T2D, 717 developed PC with a median follow-up of 45.4 months. Patients who developed PC had persistently higher eGFR and lower creatinine over time, whereas those without PC showed progressive eGFR decline and creatinine increase, with widening differences between groups. For eGFR, RCS showed a nonlinear, inverted U-shaped relationship with PC risk (overall P<0.001; nonlinearity P=0.018), peaking slightly above 100 mL/min/1.73 m². Compared with eGFR at least 90, HRs were 0.78 (95% CI 0.60-1.01) for 60-89 and 0.63 (0.30-1.34) for less than 60. For creatinine, the highest versus lowest tertile had an HR of 0.77 (0.64-0.94), whereas no significant association was observed when creatinine was modeled as a continuous variable. Conclusion: In patients with T2D, eGFR showed a nonlinear association with PC risk, while higher serum creatinine was related to lower PC risk. Distinct longitudinal trajectories of eGFR and creatinine may serve as early clinical signals of occult PC.