Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan.
PLoS One. 2014 Jun 25;9(6):e100835. doi: 10.1371/journal.pone.0100835. eCollection 2014.
Multiple studies have shown cigarette smoking to be a risk factor for chronic kidney disease. However, it is unknown whether smoking similarly increases the risk for progression of membranous nephropathy.
This study used the Nagoya Nephrotic Syndrome Cohort Study (N-NSCS), including 171 patients with idiopathic membranous nephropathy (IMN) from 10 nephrology centers in Japan. The dose-response relationships between cigarette smoking and the outcomes were assessed by using multivariate Cox proportional hazards models adjusted for clinically relevant factors. The primary outcome was a 30% decline in the estimated glomerular filtration rate (eGFR). The secondary outcome was first complete remission (CR) of proteinuria.
During the observation period (median, 37 months; interquartile range, 16-71 months), 37 (21.6%) patients developed a 30% decline in eGFR and 2 (1.2%) progressed to ESRD. CR occurred in 103 (60.2%) patients. Multivariate Cox proportional hazards models revealed current smoking (adjusted hazard ratio [HR], 7.81 [95% confidence interval (CI), 3.17-19.7]), female sex (adjusted HR, 3.58 [95% CI, 1.87-8.00]), older age (adjusted HR, 1.71 [95% CI, 1.13-2.62] per 10 years), the number of cigarettes smoked daily (adjusted HR, 1.61 [95% CI, 1.23-2.09] per 10 cigarettes daily), and cumulative smoking of ≥40 pack-years (adjusted HR, 5.56 [95% CI, 2.17-14.6]) to be associated with a 30% decline in eGFR. However, smoking was not associated with CR.
Smoking is a significant and dose-dependent risk factor for IMN progression. All patients with IMN who smoke should be encouraged to quit.
多项研究表明吸烟是慢性肾脏病的一个危险因素。然而，吸烟是否同样会增加膜性肾病进展的风险尚不清楚。
本研究使用了名古屋肾病综合征队列研究（N-NSCS），该研究纳入了来自日本 10 个肾病中心的 171 例特发性膜性肾病（IMN）患者。通过多变量 Cox 比例风险模型评估吸烟与结局之间的剂量反应关系，该模型调整了临床相关因素。主要结局是估算肾小球滤过率（eGFR）下降 30%。次要结局是蛋白尿首次完全缓解（CR）。
在观察期（中位数为 37 个月；四分位距为 16-71 个月）内，37 例（21.6%）患者的 eGFR 下降 30%，2 例（1.2%）进展为终末期肾病。103 例（60.2%）患者达到 CR。多变量 Cox 比例风险模型显示，当前吸烟（调整后的危险比 [HR]，7.81 [95%置信区间 （CI），3.17-19.7]）、女性（调整后的 HR，3.58 [95% CI，1.87-8.00]）、年龄较大（调整后的 HR，每 10 岁增加 1.71 [95% CI，1.13-2.62]）、每日吸烟量（调整后的 HR，每 10 支增加 1.61 [95% CI，1.23-2.09]）和累积吸烟量≥40 包年（调整后的 HR，5.56 [95% CI，2.17-14.6]）与 eGFR 下降 30%相关。然而，吸烟与 CR 无关。
吸烟是 IMN 进展的一个显著且剂量依赖性的危险因素。所有吸烟的 IMN 患者均应鼓励戒烟。
