Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana.
Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana; Department of Nutrition, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
Am J Kidney Dis. 2024 Nov;84(5):593-600.e1. doi: 10.1053/j.ajkd.2024.04.011. Epub 2024 Jun 22.
RATIONALE & OBJECTIVE: Although smoking is a recognized risk factor for chronic kidney disease (CKD), the relationship between the time smoking is initiated after awakening each day and CKD remains largely unstudied. This study examined the association between this timing and the risk of CKD, and the potential interactions of smoking timing with other risk factors for the occurrence of CKD.
Observational cohort study.
SETTING & PARTICIPANTS: A total of 32,776 participants in the UK Biobank with complete data on the time from waking to the first cigarette and free of prevalent CKD were included.
Time from waking to the first cigarette.
Incident CKD cases.
Cox proportional hazards regression was used to investigate the associations between the time smoking is initiated each day and the risk of CKD. The potential interactions of smoking timing with risk factors in relationship to CKD risk were assessed on both multiplicative and additive scales.
During a median follow-up period of 12 years, 940 incident CKD cases occurred. Shorter durations of time from waking to the first cigarette were associated with a higher risk of incident CKD (P trend=0.01). Compared with>120 minutes, the adjusted hazard ratio (HR) associated with smoking timing was 1.28 (95% CI, 0.92-1.80) for 61-120 minutes, 1.48 (95% CI, 1.11-1.96) for 30-60 minutes, 1.36 (95% CI, 1.01-1.88) for 5-15 minutes, and 1.70 (95% CI, 1.22-2.37) for<5 minutes, respectively. Furthermore, there was a significant additive interaction and multiplicative interactions between the timing of smoking and a healthy diet score (P for additive interaction=0.01; P for multiplicative interaction = 0.004).
Generalizability, possible residual confounding, limiting causal inference.
These findings reveal a significant association between the shorter time from waking to the first cigarette and a higher CKD risk. The magnitude of these associations was greater in the setting of an unhealthy diet.
PLAIN-LANGUAGE SUMMARY: This study explored the association of the daily timing of first cigarette smoking and the occurrence of kidney disease. Further, we addressed whether this association was influenced by the quality of the diet. The study found that smoking very soon after waking, especially when combined with a poorer quality diet, was associated with a significantly increased risk of developing chronic kidney disease. This research emphasizes the value of healthier lifestyle choices for kidney health.
尽管吸烟是慢性肾脏病（CKD）的公认危险因素，但每天吸烟开始时间与 CKD 之间的关系在很大程度上仍未得到研究。本研究旨在探讨这种时间与 CKD 风险之间的关联，以及吸烟时间与其他 CKD 发生风险因素之间的潜在相互作用。
观察性队列研究。
纳入了 UK Biobank 中总共 32776 名参与者，这些参与者的数据完整，包括从醒来到第一支香烟的时间以及无明显 CKD。
每天吸烟开始的时间。
新发 CKD 病例。
使用 Cox 比例风险回归来研究每天吸烟开始时间与 CKD 风险之间的关联。在乘法和加法尺度上评估了吸烟时间与危险因素之间的潜在相互作用对 CKD 风险的影响。
在中位随访期为 12 年期间，发生了 940 例新发 CKD 病例。从醒来到第一支香烟的时间越短，新发 CKD 的风险越高（P 趋势=0.01）。与>120 分钟相比，吸烟时间与以下情况的调整后风险比（HR）相关：61-120 分钟为 1.28（95%CI，0.92-1.80），30-60 分钟为 1.48（95%CI，1.11-1.96），5-15 分钟为 1.36（95%CI，1.01-1.88），<5 分钟为 1.70（95%CI，1.22-2.37）。此外，吸烟时间与健康饮食评分之间存在显著的相加交互作用和乘法交互作用（P 相加交互作用=0.01；P 乘法交互作用=0.004）。
推广性、可能的残余混杂、因果关系推断的限制。
这些发现揭示了从醒来到第一支香烟的时间越短与更高的 CKD 风险之间存在显著关联。在饮食不健康的情况下，这些关联的程度更大。
本研究探讨了每日第一支香烟吸烟时间与肾脏疾病发生之间的关联。此外，我们还探讨了这种关联是否受到饮食质量的影响。研究发现，醒来后很快吸烟，尤其是在饮食质量较差的情况下，与慢性肾脏病的发生风险显著增加相关。这项研究强调了更健康的生活方式选择对肾脏健康的重要性。
