Cigarette Smoking and Incident Chronic Kidney Disease: A Systematic Review

Abstract

Background: Several studies have examined the role of cigarette smoking in the development of renal disease in human populations. However, there have been no systematic reviews on the evidence linking smoking with incident renal disease. Methods: We performed an evidence-based evaluation of peer-reviewed research published during 1966–2005, from a search of five databases, including Ovid MEDLINE and EMBASE. Results: Of the 28 studies that were reviewed, 11 were excluded from the final analysis due to poor methodological quality (n = 6), no reported risk estimate for the association between smoking and kidney disease (n = 3), inability to find a Japanese translator (n = 1), and duplicate cohort (n = 1). Seventeen studies were included in the final analysis; seven studies found an overall significant association between smoking and incident chronic kidney disease, and three studies found a significantly increased risk of chronic kidney disease in current smokers that was gender and/or dose related. An increased risk of developing chronic kidney disease among smokers was significantly associated with male gender (relative risk 2.4, 95% confidence interval 1.2–4.5), >20 cigarettes smoked/day (odds ratio 1.51, 95% confidence interval 1.06–2.15, and relative risk 2.3, 95% confidence interval 1.2–4.3), and smoking >40 years (odds ratio 1.45, 95% confidence interval 1.00–2.09). A pooled estimate of the relative risk (meta-analysis) was deemed inappropriate due to the heterogeneity in methodologies utilized by the different studies. Conclusions: This comprehensive review reveals overall evidence for current cigarette smoking as a risk factor for incident chronic kidney disease. Further investigation is needed to more carefully examine the strength of the association between cigarette smoking and incident kidney disease.

Smoking Is a Risk Factor for Graft Failure and Mortality after Renal Transplantation

“…In prospective studies in patients with diabetes, it has been shown that smoking is a risk factor for development and progression of diabetic nephropathy to end-stage renal disease [3,4,5]. Similar findings have been done in prospective studies in patients with primary renal diseases, including lupus nephritis, autosomal polycystic kidney disease and IgA nephropathy, in which smoking was found to be a risk factor for decline in renal function and subsequent progression to end-stage renal disease [6,7,8]. …”

Aging Promotes Progression of IgA Nephropathy: A Systematic Review and Meta-Analysis

“…The evaluation criteria for the cohort studies were the following: (1) initial assembly of the cohort; (2) maintenance of comparable groups; (3) attrition; (4) clear definitions of exposure; (5) assessment of measurements; (6) adjustment for important potential confounders, and (7) inclusion of all important results [15]. Instead of scores, we used ‘good', ‘fair', and ‘fail' to judge the overall quality of the included studies.…”

Cigarette smoking and chronic kidney diseases

“…11 The increased risk of developing CKD among smokers vs. non-smokers was reported to be associated with smoking 420 cigarettes per day (odds ratio, 1.51; 95% CI, 1.06-2.15), male (odds ratio, 2.4; 95% CI, 1.2-4.5) and smoking for over 40 years (odds ratio, 2.3; 95% CI, 1.2-4.3). 11 However, this meta-analysis included only five articles analyzing the dose-dependency between the number of cigarettes smoked and CKD, and no significant relationship was found between CKD incidence and smoking fewer than 20 cigarettes per day.…”