The role of cigarette smoking on new-onset of chronic kidney disease in a Japanese population without prior chronic kidn
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ORIGINAL ARTICLE
The role of cigarette smoking on new‑onset of chronic kidney disease in a Japanese population without prior chronic kidney disease: Iki epidemiological study of atherosclerosis and chronic kidney disease (ISSA‑CKD) Kenji Ito1 · Toshiki Maeda2 · Kazuhiro Tada1,2 · Koji Takahashi1 · Tetsuhiko Yasuno1 · Kosuke Masutani1 · Shigeaki Mukoubara3 · Hisatomi Arima2 · Hitoshi Nakashima1 Received: 2 April 2020 / Accepted: 10 June 2020 © Japanese Society of Nephrology 2020
Abstract Background Studies regarding harmful effects of smoking on the new-onset of chronic kidney disease (CKD) have been limited. Thus, we collected and retrospectively studied 8 years of data from the annual health check-ups of the residents in Iki City (Nagasaki Prefecture, Japan). Methods From 2008 to 2016, 4540 adults were enrolled in the study. Information on smoking habits was obtained via a self-reported questionnaire. New-onset CKD was defined as a reduction of the estimated globular filtration rate (eGFR) to less than 60 mL/min/1.73 m2 and/or new-onset proteinuria during the follow-up examinations. Results During an average follow-up of 4.6 years, proteinuria developed in 218 people (10.4 per 1000 person-years) and eGFR decline to less than 60 mL/min/1.73 m2 was confirmed in 594 people (28.3 per 1000 person-years) including 53 who showed both proteinuria and eGFR reduction (2.8 per 1000 person-years). In terms of proteinuria, current smokers showed a higher incidence than non-smokers (14.1 and 9.17 per 1000 person-years, respectively, p = 0.001), and a significantly high hazard ratio (HR) of 1.39 with a 95% CI of 1.01–1.92 in multivariable Cox’s proportional-hazard analyses. The tendency was more drastic among younger participants (p = 0.015 for trend): current smokers who were 90 mmHg, and/or use of blood pressurelowering medications [18]. Obesity was defined as a body mass index of 25 kg/m2 or more [19]. Serum glucose levels were determined by the enzyme method, and individuals with a fasting glucose level ≥ 126 mg/dL, non-fasting glucose level ≥ 200 mg/dL, hemoglobin A1c (HbA1c/National Glycohemoglobin Standardization Program) ≥ 6.5% or use of glucose-lowering treatment were diagnosed as DM [20]. Serum low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglyceride levels were determined enzymatically. Dyslipidemia was defined as LDL cholesterol level ≥ 140 mg/dL, HDL cholesterol level
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