Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK.
Department of Medicine, University of Ghana Hospital, Legon, Ghana.
Nephrol Dial Transplant. 2024 Sep 27;39(10):1683-1691. doi: 10.1093/ndt/gfae054.
Evidence on the role of smoking in the development of chronic kidney disease (CKD) has mostly relied on self-reported smoking status. We aimed to compare the associations of smoking status as assessed by self-reports and urine cotinine with CKD risk.
Using the PREVEND prospective study, smoking status was assessed at baseline using self-reports and urine cotinine in 4333 participants (mean age, 52 years) without a history of CKD at baseline. Participants were classified as never, former, light current, and heavy current smokers according to self-reports and comparable cutoffs for urine cotinine. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated for CKD.
The percentages of self-reported and cotinine-assessed current smokers were 27.5% and 24.0%, respectively. During a median follow-up of 7.0 years, 593 cases of CKD were recorded. In analyses adjusted for established risk factors, the HRs (95% CI) of CKD for self-reported former, light current, and heavy current smokers compared with never smokers were 1.17 (0.95-1.44), 1.48 (1.10-2.00), and 1.48 (1.14-1.93), respectively. On further adjustment for urinary albumin excretion (UAE), the HRs (95% CI) were 1.07 (0.87-1.32), 1.26 (0.93-1.70), and 1.20 (0.93-1.57), respectively. For urine cotinine-assessed smoking status, the corresponding HRs (95% CI) were 0.81 (0.52-1.25), 1.17 (0.92-1.49), and 1.32 (1.02-1.71), respectively, in analyses adjusted for established risk factors plus UAE.
Self-reported current smoking is associated with increased CKD risk, but dependent on UAE. The association between urine cotinine-assessed current smoking and increased CKD risk is independent of UAE. Urine cotinine-assessed smoking status may be a more reliable risk indicator for CKD incidence than self-reported smoking status.
关于吸烟在慢性肾脏病（CKD）发展中的作用的证据主要依赖于自我报告的吸烟状况。我们旨在比较通过自我报告和尿液可替宁评估的吸烟状况与 CKD 风险之间的关联。
使用 PREVEND 前瞻性研究，在基线时使用自我报告和尿液可替宁评估 4333 名参与者（平均年龄 52 岁）的吸烟状况，这些参与者在基线时均无 CKD 病史。根据自我报告和尿液可替宁的可比截断值，参与者被分类为从不吸烟者、前吸烟者、轻度当前吸烟者和重度当前吸烟者。估计 CKD 的风险比（HRs）及其 95%置信区间（CIs）。
自我报告和可替宁评估的当前吸烟者的百分比分别为 27.5%和 24.0%。在中位随访 7.0 年期间，记录了 593 例 CKD 病例。在调整了既定危险因素后，与从不吸烟者相比，自我报告的前吸烟者、轻度当前吸烟者和重度当前吸烟者的 CKD HRs（95%CI）分别为 1.17（0.95-1.44）、1.48（1.10-2.00）和 1.48（1.14-1.93）。在进一步调整尿白蛋白排泄（UAE）后，HRs（95%CI）分别为 1.07（0.87-1.32）、1.26（0.93-1.70）和 1.20（0.93-1.57）。对于尿液可替宁评估的吸烟状况，在调整既定危险因素加 UAE 后，相应的 HRs（95%CI）分别为 0.81（0.52-1.25）、1.17（0.92-1.49）和 1.32（1.02-1.71）。
自我报告的当前吸烟与 CKD 风险增加相关，但依赖于 UAE。尿液可替宁评估的当前吸烟与 CKD 风险增加之间的关联独立于 UAE。与自我报告的吸烟状况相比，尿液可替宁评估的吸烟状况可能是 CKD 发病率的更可靠风险指标。
