Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Rev Invest Clin. 2021 Apr 12;73(4):238-244. doi: 10.24875/RIC.20000622.
The negative impact of tobacco smoking on renal function has been widely studied. However, there is limited knowledge about the effect of smoking on pre-operative and post-operative renal function in living kidney donors.
The objective of the study was to evaluate the short- and mid-term impact of smoking on donor renal function.
This is a retrospective study of 308 patients who underwent living donor nephrectomy (LDN) at a tertiary referral hospital. We compared baseline characteristics as well as functional outcomes following LDN according to history of tobacco smoking. Estimated glomerular filtration rate (eGFR) was calculated with the modification of diet in renal disease equation in 6 time periods: pre-operative, 1 week, 1 month, 6 months, 12 months, and 24 months after surgery. We performed a Kaplan-Meier analysis for chronic kidney disease (CKD) outcome and binary logistic regression analysis to identify risk factors associated with CKD at 24 months of follow-up.
Among donors, 106 (34.4%) reported a smoking history before nephrectomy. Smoking donors had worse pre-operative eGFR than non-smokers (90 ± 26.3 mL/min/1.73m2 vs. 96 ± 27 mL/min/1.73 m2, respectively; p = 0.02) and lower eGFR at 1 week (p = 0.01), 1 month (p ≤ 0.01), 6 months (p = 0.01), and 12 months (p = 0.01) after LDN. Tobacco smoking (OR 3.35, p ≤ 0.01) and age ≥ 40 years at donation (OR 6.59, p ≤ 0.01) were associated with post-operative development of CKD at 24 months after LDN.
Living kidney donors with a tobacco smoking history had an increased risk of developing chronic kidney disease following nephrectomy. Smoking-cessation strategies should be implemented.
烟草吸烟对肾功能的负面影响已得到广泛研究。然而，对于吸烟对活体供肾者术前和术后肾功能的影响知之甚少。
本研究旨在评估吸烟对供者肾功能的短期和中期影响。
这是一项对在一家三级转诊医院接受活体供肾切除术（LDN）的 308 名患者进行的回顾性研究。我们比较了吸烟史患者的基线特征和 LDN 后的功能结果。采用肾脏病饮食改良公式（MDRD）计算肾小球滤过率（eGFR），共 6 个时间点：术前、术后 1 周、1 个月、6 个月、12 个月和 24 个月。我们进行了 Kaplan-Meier 分析以评估慢性肾脏病（CKD）结局，并进行二项逻辑回归分析以确定 24 个月随访时与 CKD 相关的危险因素。
在供者中，106 名（34.4%）报告术前有吸烟史。吸烟供者的术前 eGFR 较不吸烟者差（90 ± 26.3 mL/min/1.73 m2 vs. 96 ± 27 mL/min/1.73 m2，p = 0.02），且术后 1 周（p = 0.01）、1 个月（p ≤ 0.01）、6 个月（p = 0.01）和 12 个月（p = 0.01）的 eGFR 较低。吸烟（OR 3.35，p ≤ 0.01）和供肾时年龄≥40 岁（OR 6.59，p ≤ 0.01）与 LDN 后 24 个月时 CKD 的发生相关。
有吸烟史的活体供肾者在接受肾切除术后发生慢性肾脏病的风险增加。应实施戒烟策略。
