Haroun Melanie K, Jaar Bernard G, Hoffman Sandra C, Comstock George W, Klag Michael J, Coresh Josef
Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
J Am Soc Nephrol. 2003 Nov;14(11):2934-41. doi: 10.1097/01.asn.0000095249.99803.85.
Chronic kidney disease (CKD) is an increasing cause of morbidity and mortality in the United States. Prospective data on risk factors for CKD are limited to men, and few studies examine the importance of smoking. The authors performed a community-based, prospective observational study of 20-yr duration to examine the association between hypertension and smoking on the future risk of CKD in 23,534 men and women in Washington County, Maryland. CKD was identified as end-stage renal disease in the Health Care Financing Administration database or kidney disease listed on the death certificate. All cases were confirmed as CKD by medical chart review. Adjusted relative hazards of CKD were modeled using Cox proportional hazards regression including age as the time variable and baseline BP, cigarette smoking, gender, and diabetes status as risk factors. The adjusted hazard ratio (95% confidence interval) of developing CKD among women was 2.5 (0.05 to 12.0) for normal BP, 3.0 (0.6 to 14.4) for high-normal BP, 3.8 (0.8 to 17.2) for stage 1 hypertension, 6.3 (1.3 to 29.0) for stage 2 hypertension, and 8.8 (1.8 to 43.0) for stages 3 or 4 hypertension compared with individuals with optimal BP. In men, the relationship was similar but somewhat weaker than in women, with corresponding hazard ratios of 1.4 (0.2 to 12.1), 3.3 (0.4 to 25.6), 3.0 (0.4 to 22.2), 5.7 (0.8 to 43.0), and 9.7 (1.2 to 75.6), respectively. Current cigarette smoking was also significantly associated with risk of CKD in both men and women (hazard ratio in women 2.9 [1.7 to 5.0] and in men 2.4 [1.5 to 4.0]). A large proportion of the attributable risk of CKD in this population was associated with stage 1 hypertension (23%) and cigarette smoking (31%). In conclusion, CKD risk shows strong graded relationships to the sixth report of the Joint National Committee (JNC-VI) on Prevention, Detection Evaluation and Treatment of High BP criteria for BP, to diabetes, and to current cigarette smoking that are at least as strong in women as in men.
慢性肾脏病（CKD）在美国正日益成为发病和死亡的一个原因。关于CKD危险因素的前瞻性数据仅限于男性，很少有研究探讨吸烟的重要性。作者进行了一项为期20年的基于社区的前瞻性观察性研究，以检验马里兰州华盛顿县23534名男性和女性中高血压与吸烟对未来CKD风险的关联。CKD在医疗保健财务管理局数据库中被确定为终末期肾病或死亡证明上列出的肾病。所有病例均通过病历审查确认为CKD。使用Cox比例风险回归模型对CKD的调整后相对风险进行建模，将年龄作为时间变量，将基线血压、吸烟、性别和糖尿病状态作为危险因素。与血压最佳的个体相比，女性中血压正常者发生CKD的调整后风险比（95%置信区间）为2.5（0.05至12.0），血压正常高值者为3.0（0.6至14.4），1期高血压者为3.8（0.8至17.2），2期高血压者为6.3（1.3至29.0），3或4期高血压者为8.8（1.8至43.0）。在男性中，这种关系与女性相似但稍弱，相应的风险比分别为1.4（0.2至12.1）、3.3（0.4至25.6）、3.0（0.4至22.2）、5.7（0.8至43.0）和9.7（1.2至75.6）。当前吸烟在男性和女性中也与CKD风险显著相关（女性风险比为2.9 [1.7至5.0]，男性为2.4 [1.5至4.0]）。该人群中CKD的很大一部分可归因风险与1期高血压（23%）和吸烟（31%）有关。总之，CKD风险与美国国家联合委员会（JNC-VI）关于高血压预防、检测、评估和治疗标准的第六次报告中的血压、糖尿病以及当前吸烟呈强烈的分级关系，在女性中至少与男性一样强烈。
