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Smoking, Smoking Cessation, and Progression of Chronic Kidney Disease: Results From KNOW-CKD Study

 Sangmi Lee  ;  Shinchan Kang  ;  Young Su Joo  ;  Changhyun Lee  ;  Ki Heon Nam  ;  Hae-Ryong Yun  ;  Jung Tak Park  ;  Tae Ik Chang  ;  Tae-Hyun Yoo  ;  Soo Wan Kim  ;  Kook-Hwan Oh  ;  Yeong Hoon Kim  ;  Sue K Park  ;  Shin-Wook Kang  ;  Kyu Hun Choi  ;  Curie Ahn  ;  Seung Hyeok Han 
 NICOTINE & TOBACCO RESEARCH, Vol.23(1) : 92-98, 2021-01 
Journal Title
Issue Date
Disease Progression ; Female ; Glomerular Filtration Rate ; Humans ; Incidence ; Male ; Middle Aged ; Prospective Studies ; Renal Insufficiency, Chronic / epidemiology* ; Renal Insufficiency, Chronic / physiopathology ; Renal Insufficiency, Chronic / prevention & control ; Republic of Korea / epidemiology ; Risk Factors ; Smoking / adverse effects* ; Smoking Cessation / methods*
Introduction: In patients with chronic kidney disease (CKD), studies investigating the association between smoking and deterioration of kidney function are scarce. Aims and methods: We analyzed data for 1,951 patients with an estimated glomerular filtration rate (eGFR) ≥15 mL/min/1.73 m2 enrolled in the KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD) from 2011 to 2016. Patients were categorized by smoking load. Primary outcome was a composite of a ≥50% reduction in eGFR, initiation of dialysis, or kidney transplantation. Results: There were 967 never-smokers and 369, 276, and 339 smokers who smoked <15, 15 to 29, ≥30 pack-years, respectively. During a mean follow-up of 3.0 years, the incidence rates (95% confidence interval [CI]) of the primary outcome were 54.3 (46.4-63.5), 46.9 (35.9-61.4), 69.2 (52.9-90.6), and 76.3 (60.7-96.0) events per 1,000 person-yr in never-, <15, 15 to 29, and ≥30 pack-year smokers. In cause-specific hazard model after adjustment of confounding factors, smokers were associated with 1.09 (0.73-1.63), 1.48 (1.00-2.18), and 1.94 (1.35-2.77) fold increased risk (95% CI) of primary outcome in <15, 15-29, and ≥30 pack-year smokers compared with never-smokers. The association of longer smoking duration with higher risk of CKD progression was evident particularly in patients with eGFR < 45 mL/min/1.73 m2 and proteinuria ≥ 1.0 g/g. In contrast, the risk of adverse kidney outcome decreased with longer smoking-free periods among former-smokers. Conclusions: These findings suggest potentially harmful effects of the degree of exposure to smoking on the progression of CKD. Implications: Among patients with CKD, there has been lack of studies on the association between smoking and CKD progression and studies to date have yielded conflicting results. In this prospective cohort study involving Korean CKD patients, smoking was associated with significantly higher risk of worsening kidney function. Furthermore, the risk of adverse kidney outcome was incrementally higher as smoking pack-years were higher. As the duration of smoking cessation increased, the hazard ratios for adverse kidney outcome were attenuated, suggesting that quitting smoking may be a modifiable factor to delay CKD progression.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Kang, Shinchan(강신찬)
Nam, Ki Heon(남기헌) ORCID logo https://orcid.org/0000-0001-7312-7027
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Yun, Hae Ryong(윤해룡) ORCID logo https://orcid.org/0000-0002-7038-0251
Lee, Sangmi(이상미) ORCID logo https://orcid.org/0000-0002-3619-0809
Lee, Changhyun(이창현)
Joo, Young Su(주영수) ORCID logo https://orcid.org/0000-0002-7890-0928
Choi, Kyu Hun(최규헌) ORCID logo https://orcid.org/0000-0003-0095-9011
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
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