Department of Nephrology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Department of Rheumatology, Shanghai Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Nephrol Dial Transplant. 2017 Mar 1;32(3):475-487. doi: 10.1093/ndt/gfw452.
Cigarette smoking has been established as a major risk factor for chronic kidney disease (CKD) development in people with diabetes. Conflicting evidence exists among representative community-based studies as to whether smoking is an independent risk factor for CKD. The aim of this meta-analysis was to assess the effects of tobacco smoking on the development of CKD in adult general populations.
A literature search was conducted using MEDLINE and Embase from their inception through 31 May 2016 for prospective cohort studies that reported relative risks of CKD with smoking status in the general population. Summary relative risks (SRRs) and 95% confidence intervals (CIs) were calculated using a random effects model.
A total of 15 prospective cohort studies, including 65 064 incident CKD cases, were included. Compared with never-smokers, the SRRs of incident CKD were 1.27 (95% CI 1.19-1.35) for ever-smokers, 1.34 (95% CI 1.23-1.47) for current smokers and 1.15 (95% CI 1.08-1.23) for former smokers. The SRRs for end-stage renal disease development were 1.51 (95% CI 1.24-1.84) for ever-smokers, 1.44 (95% CI 1.00-2.09) for former smokers and 1.91 (95% CI 1.39-2.64) for current smokers. Considerable heterogeneity was observed among these studies. After combining an additional three prospective cohort studies, which involved 5747 incident proteinuria cases, a null smoking-proteinuria association in the general population was observed.
Our meta-analysis suggests evidence for cigarette smoking as an independent risk factor for incident CKD. Future studies are required to investigate whether smoking cessation can decrease incident CKD in the general adult population.
吸烟已被确定为糖尿病患者慢性肾脏病（CKD）发展的主要危险因素。在具有代表性的基于社区的研究中，关于吸烟是否是 CKD 的独立危险因素存在相互矛盾的证据。本荟萃分析的目的是评估吸烟对普通人群 CKD 发展的影响。
使用 MEDLINE 和 Embase 从其创建到 2016 年 5 月 31 日进行文献检索，以寻找报告普通人群中吸烟状况与 CKD 相关的前瞻性队列研究。使用随机效应模型计算汇总相对风险（SRR）和 95%置信区间（CI）。
共纳入 15 项前瞻性队列研究，包括 65064 例新发 CKD 病例。与从不吸烟者相比，曾经吸烟者、当前吸烟者和曾经吸烟者新发 CKD 的 SRR 分别为 1.27（95%CI 1.19-1.35）、1.34（95%CI 1.23-1.47）和 1.15（95%CI 1.08-1.23）。终末期肾病发展的 SRR 分别为 1.51（95%CI 1.24-1.84）、1.44（95%CI 1.00-2.09）和 1.91（95%CI 1.39-2.64）。这些研究之间存在很大的异质性。在纳入另外三项涉及 5747 例新发蛋白尿病例的前瞻性队列研究后，观察到普通人群中吸烟与蛋白尿之间无关联。
我们的荟萃分析表明，吸烟是新发 CKD 的独立危险因素。需要进一步的研究来调查戒烟是否可以降低普通成年人群中新发 CKD 的发生率。
