Risk of End-stage Renal Disease Associated with Alcohol Consumption

Abstract

Alcohol consumption has been linked to kidney disorders in selected patient groups, but whether it contributes to the burden of end-stage renal disease (ESRD) in the general population is unknown. The authors conducted a population-based case-control study to assess the relation between alcohol consumption and risk of ESRD. The study took place in Maryland, Virginia, West Virginia, and Washington, DC, in 1991. Participants were 716 patients who had started treatment for ESRD and 361 control subjects of similar age (20-64 years) selected by random digit dialing. The main risk factor of interest was self-reported consumption of alcoholic beverages (frequency of drinking days and number of drinks consumed per drinking day). In univariate analysis, consumption of alcohol exhibited a J-shaped association with risk of ESRD. The J shape disappeared after exclusion of persons who had ever consumed home-distilled whiskey ("moonshine") and adjustment for age, race, sex, income, history of hypertension, history of diabetes mellitus, use of acetaminophen, use of opiates, and cigarette smoking; however, the odds ratio for ESRD remained significantly increased (odds ratio = 4.0; 95% confidence interval: 1.2, 13.0) among persons who consumed an average of >2 alcoholic drinks per day. The corresponding population attributable risk was 9 percent. Thus, consumption of more than two alcoholic drinks per day, on average, was associated with an increased risk of kidney failure in the general population. A lower intake of alcohol did not appear to be harmful. Because these results are based on self-reports in a case-control study, they should be seen as preliminary. Am J Epidemiol 1999;150:1275-81. alcohol drinking; ethanol; kidney failure, chronic Prevention of end-stage renal disease (ESRD) requires knowledge of modifiable risk factors responsible for initiation and promotion of renal insufficiency (1). Modifiable risk factors for kidney failure that have been identified in population-based studies include high blood pressure (2), diabetes mellitus (3), exposure to occupational nephrotoxins (4), and chronic use of analgesics (5). However, known risk factors explain only a limited part of the overall incidence of ESRD.Alcohol consumption is a plausible risk factor for ESRD. Historically, alcoholism or intemperance was suspected of causing kidney failure by Richard Bright

Insulin Sensitivity Measured With Euglycemic Clamp Is Independently Associated With Glomerular Filtration Rate in a Community-Based Cohort

“…However, as insulin sensitivity was associated with GFR in individuals with otherwise normal glucose metabolism after adjustment for both fasting and postload glucose levels, higher glucose levels are not a likely explanation for the results in the present study. Also, insulin sensitivity is associated with several glucometabolic, cardiovascular risk, and lifestyle factors that have been shown to be associated with a reduced GFR and the development of chronic kidney disease (2,12,(21)(22)(23). The fact that insulin sensitivity remained significantly associated with GFR in all multivariable models suggests that confounding by these factors does not explain our findings.…”

The association of alcohol and smoking with CKD in a Japanese nationwide cross-sectional survey

“…On the one hand, alcohol consumption has been associated with the risk of CKD. 28,33 A population-based cohort study in the United States reported that drinking ⩾ 4 servings daily was independently associated with an increased CKD risk 28 (each serving of beer, wine and liquor was considered to contain 12.96, 11.48 and 14.00 g of ethanol, respectively 34 ). A case-control study in the United States reported that the consumption of more than two alcoholic drinks per day was associated with an increased risk of ESRD and that a lower intake of alcohol did not appear to be harmful.…”

“…A case-control study in the United States reported that the consumption of more than two alcoholic drinks per day was associated with an increased risk of ESRD and that a lower intake of alcohol did not appear to be harmful. 33 On the other hand, alcohol consumption has been inversely associated with the risk of CKD. [25][26][27][35][36][37] A prospective cohort study of 11 023 initially healthy male physicians in the United States reported a significantly lower risk of renal dysfunction (defined as serum creatinine ⩾ 1.5 mg/dl and eGFR ⩽ 55 ml/min) in those who consumed at least 7 drinks weekly.…”

Association between frequency of drinking alcohol and chronic kidney disease in men

“…We could not find any potential harmful effects regarding the frequency of drinking alcohol on CKD. A case-control study of 716 patients with incident ESRD and 361 age-matched population controls conducted by Perneger et al [15] showed the presence of a significantly increased risk of ESRD among individuals who consumed more than 2 drinks per day as compared with those who abstained from alcohol (OR: 4.0; 95% CI, 1.2-13.0). In addition, Shankar et al [12] examined the association between CKD and heavy alcohol consumption in a 5-year longitudinal analysis of 3,392 Americans without CKD.…”

“…However, epidemiological studies of the relationship between alcohol consumption and CKD are scarce. A few studies have indicated that moderate alcohol consumption was not associated with increased risk of renal dysfunction [13] and was associated with only a low risk of cardiovascular mortality in CKD patients [14], whereas other studies showed that heavy drinking was associated with a high risk of CKD [12] and end-stage renal disease (ESRD) [15]. In addition, a few previous studies [9,16] showed that alcohol consumption was not associated with CKD.…”