| The purpose of this dissertation was to explore the association between cigarette smoking and kidney dysfunction. Smoking has been reported to be a risk factor for the progression of several established kidney diseases, including diabetic nephropathy, the leading cause of kidney failure. The association of smoking and kidney dysfunction in the general population has not been well described; therefore, two studies were carried out to expand the research in this area.; The third National Health and Nutrition Evaluation Survey (NHANES III) provided a cross-sectional sample representative of the US population (1988–1994) of 16,405 adults (ages 18 to 90). The association of pack-years (PY) of smoking with albuminuria (urine albumin-to-creatinine ratio ≥17 μg/mg in males; ≥25 μg/mg in females) was evaluated with multivariable logistic regression. Compared to non-smokers, ≥40 PY was associated with albuminuria among both current (40 to 59 PY, Relative Risk (RR) = 1.74, 95% CI = 1.09–2.78; and ≥60 PY, RR = 2.28, 95% CI = 1.47–3.54) and former smokers (40 to 59 PY, RR = 1.45, 95% CI = 1.12–1.87; and ≥60 PY, RR = 1.53, 95% CI = 1.09–2.13). The risk persisted informer smokers with ≥40 PY even with smoking cessation of ≥15 years.; In the Atherosclerosis Risk in Communities (ARIC) study, 13,920 adults (aged 45 to 64 at entry) were followed for a median of 8.8 years. Development of kidney dysfunction was defined as an increase in serum creatinine of ≥0.4 mg/dl or a diagnosis of chronic kidney disease during the follow-up. Multivariable survival analysis was used to evaluate the effect of PY on time to reaching the renal outcome. Current smoking was associated with kidney dysfunction across all PY levels compared to non-smokers (1 to 19 PY, Hazard Ratio (HR) = 1.47, 95% CI:1.07–2.01; 20 to 39 PY, HR = 1.51, 95% CI:1.15–1.99; ≥40 PY, HR = 1.34, 95% CI:1.03–1.75). In former smokers, only those who had quit smoking for <5 years and smoked ≥30 PY (HR = 2.15, 95% CI:1.39–3.32) remained at risk.; These studies provide support for an association between smoking and kidney dysfunction in general populations. Smoking cessation may lower the risk for the development of kidney dysfunction, but in heavy smokers the risk of albuminuria may persist for many years. |
