CKD Risk Higher With Secondhand Smoke Exposure

Jennifer Garcia

March 07, 2019

Exposure to secondhand smoke is linked with the development of chronic kidney disease (CKD) among nonsmokers, according to a large cohort study published online today in the Clinical Journal of the American Society of Nephrology.

Jung Tak Park, MD, PhD, from Yonsei University College of Medicine, Seoul, Korea, and colleagues analyzed data from 131,196 participants in the Korean Genome and Epidemiology Study between 2001 to 2014; none of the participants had a history of smoking. The researchers stratified participants into three groups based on secondhand smoke exposure: no exposure, less than 3 days/week, or 3 or more days/week.

The majority (75%) of the subjects were women, the mean age was 53 years, and the average estimated glomerular filtration rate (eGFR) was 92 ± 14 mL/min/1.73m2.

Park and colleagues found a diagnosis of CKD, defined as eGFR levels <60 mL/min/1.73m2, in 231 (1.8%) of those in the highest exposure group, 64 (1.7%) in the lower exposure group, and 2280 (2.0%) of those with no exposure.

Overall, the odds of developing CKD were 1.48-times greater in subjects exposed to secondhand smoke when compared with those with no exposure (95% confidence interval [CI], 1.25 – 1.74), after adjusting for age, sex, body mass index, systolic blood pressure, history of hypertension, history of diabetes, alcohol status, education levels, income levels, marital status, hemoglobin, and serum albumin.

Further, in 125,371 subjects for whom data was available, Park and colleagues found that "prevalent CKD was significantly associated with life-time secondhand smoke exposure duration when the duration was longer than 10 years."

In a longitudinal analysis, the researchers evaluated the risk for incident CKD among a subgroup of 1948 subjects for whom data were available. Of those, 80% were exposed to secondhand smoke.

Over an average follow-up of 8.7-years, 319 subjects (16%) developed CKD and those exposed to secondhand smoke had 1.64-times greater risk for CKD (95% CI, 1.03 – 2.60), when compared with those with no exposure.

The authors acknowledge limitations in the study, such as the difficulty of accurately quantifying the amount of secondhand smoke exposure and lack of data regarding the use of renoprotective or potentially nephrotoxic medications.

"Lowering the chance of secondhand smoke exposure by enhancing public smoking restriction policies and educating the public about the potential harm of household tobacco use could reduce the risk of CKD development in the nonsmoking population with normal kidney function," Park and colleagues conclude.

Funding for this study was provided through a grant from the Ministry for Health and Welfare, Republic of Korea; and a grant from Inha University Hospital. The authors have disclosed no relevant financial relationships.

Clin J Am Soc Nephrol. Published online March 7, 2019. Abstract

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