Son Young-Bin, Kim Tae-Bum, Min Hyeon-Jin, Yang Jihyun, Kim Myung-Gyu, Jo Sang Kyung, Cho Won Yong, Oh Se Won
Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Division of Nephrology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Kidney Res Clin Pract. 2025 May;44(3):452-460. doi: 10.23876/j.krcp.22.133. Epub 2023 Oct 24.
Smoking and sodium intake (SI) have been evaluated as risk factors for kidney disease; however, the data are inconsistent. We assessed the association between SI and cotinine-verified smoking status and the risk of albuminuria.
An observational study using the Korea National Health and Nutrition Examination Survey (2008-2011 and 2014- 2018) was performed. We included 37,410 adults with an estimated glomerular filtration rate of ≥60 mL/min/1.73 m2. The smoking status was assumed based on the urine cotinine/creatinine ratio (Ucot/Ucrea). SI was estimated from spot urine sodium using the Kawasaki formula.
Ucot/Ucrea levels were significantly higher in current smokers (920.22 ± 9.00 ng/mg) than in ex-smokers and nonsmokers (48.31 ± 2.47 and 23.84 ± 1.30 ng/mg) (p < 0.001). Ucot/Ucrea levels were significantly higher in second-hand smokers than in participants without a history of smoking (p < 0.001). Ucot/Ucrea levels were positively associated with SI (p for trend < 0.001). Smoking status was not associated with albuminuria. SI had a linear relationship with albuminuria (p < 0.001). In groups with the highest Ucot/Ucrea levels, the highest SI quartile indicated a significantly higher risk of albuminuria than that in the lowest quartile (risk ratio, 2.22; 95% confidence interval, 1.26-3.92; p = 0.006). The risk of albuminuria was not significant in groups with the lowest and middle tertile adjusted for multiple risk factors.
Smokers consume higher dietary sodium and dietary SI was positively related to the risk of albuminuria. Smoking is not associated with albuminuria as a single factor. The risk of albuminuria is the higher in participants with smoking and high SI.
吸烟和钠摄入量（SI）已被评估为肾脏疾病的危险因素；然而，数据并不一致。我们评估了SI与可替宁验证的吸烟状态之间的关联以及蛋白尿的风险。
采用韩国国家健康与营养检查调查（2008 - 2011年和2014 - 2018年）进行了一项观察性研究。我们纳入了37410名估计肾小球滤过率≥60 mL/min/1.73 m²的成年人。根据尿可替宁/肌酐比值（Ucot/Ucrea）来推断吸烟状态。使用川崎公式从随机尿钠中估算SI。
当前吸烟者的Ucot/Ucrea水平（920.22±9.00 ng/mg）显著高于既往吸烟者和非吸烟者（48.31±2.47和23.84±1.30 ng/mg）（p<0.001）。二手吸烟者的Ucot/Ucrea水平显著高于无吸烟史的参与者（p<0.001）。Ucot/Ucrea水平与SI呈正相关（趋势p<0.001）。吸烟状态与蛋白尿无关。SI与蛋白尿呈线性关系（p<0.001）。在Ucot/Ucrea水平最高的组中，SI最高四分位数组的蛋白尿风险显著高于最低四分位数组（风险比，2.22；95%置信区间，1.26 - 3.92；p = 0.006）。在调整了多个危险因素后，最低和中间三分位数组的蛋白尿风险不显著。
吸烟者摄入的膳食钠更高，膳食SI与蛋白尿风险呈正相关。吸烟作为单一因素与蛋白尿无关。吸烟且SI高的参与者蛋白尿风险更高。
