Water-Pipe Smoking and Albuminuria: New Dog with Old Tricks

Abstract

Water-pipe (WP) smoking is on rise worldwide for the past few years, particularly among younger individuals. Growing evidence indicates that WP smoking is as harmful as cigarette smoking. To date, most of the research has focused on acute health effects of WP smoking, and evidence remains limited when it comes to chronic health effects in relation to long-term WP smoking. Therefore, the aim of this study was to examine the association between WP smoking and albuminuria in apparently healthy individuals. This analysis was conducted on data of a population-based cross-sectional study—the Urban Rural Chronic Diseases Study (URCDS). The study sample was recruited from three sites in Pakistan. Trained nurses carried out individual interviews and obtained the information on demographics, lifestyle factors, and past and current medical history. Measurements of complete blood count, lipid profile, fasting glucose level, and 24-hour albuminuria were also made by using blood and urine samples. Albumin excretion was classified into three categories using standard cut-offs: normal excretion, high-normal excretion and microalbuminuria. Multiple logistic regression models were used to examine the relationship between WP smoking and albuminuria. The final analysis included data from 1,626 health individuals, of which 829 (51.0%) were males and 797 (49.0%) females. Of 1,626 individuals, 267 (16.4%) were current WP smokers and 1,359 (83.6%) were non-WP smokers. WP smoking was significantly associated with high-normal albuminuria (OR = 2.33, 95% CI 1.68-3.22, p-value <0.001) and microalbuminuria (OR = 1.75, 95% CI 1.18-2.58, p-value 0.005) after adjustment for age, sex, BMI, social class, hypertension, and diabetes mellitus. WP smoking was significantly associated with high-normal albuminuria and microalbuminuria when analysis was stratified on hypertension and diabetes mellitus categories. WP smoking has a strong association with albuminuria in apparently healthy individuals. More research is warranted to evaluate the temporality of this association between WP smoking and albuminuria.

Relation between Tobacco Smoking/Electronic Smoking and Albuminuria/Vascular Stiffness in Young People without Cardiovascular Diseases

“…Our results showed statistically significantly higher AU levels associated with both traditional tobacco smoking and vaping (e-smoking) among young healthy subjects without any known CVD. Our data correspond to a number of studies [10][11] which mentioned that smoking cessation is associated with a decrease in AU levels and an improved prognosis even in groups of patients with already diagnosed type 2 diabetes mellitus and chronic kidney disease [9]. Our data resulted from a semiquantitative dipstick test for albuminuria, which is less accurate then quantitative methods; this may be a limitation of our study.…”

“…The associations between tobacco smoking, smoking duration, smoking index, and AU have been proven in numerous studies not only in groups of patients with diabetes mellitus and hypertension but also in healthy subjects [9][10][11]16]. Currently AU is regarded as an early prognostically unfavorable marker not only for chronic kidney disease but also for CVD and their complications.…”

“…There are data supporting a potential role of vitamin E acetate in EVALI [20]. The association of vaping with the development of chronic noninfectious diseases including CVD has been described in occasional studies mainly with small sample sizes [5,11,21]. According to the available data, chronic pathologic effects from vaping are related to the sympathomimetic effects of nicotine and other poorly studied chemical agents contained in vapor [22].…”

“…AU onset and progression caused by tobacco smoking are probably related to activation of oxidation and glycation of proteins and lipids associated with the increase in vascular permeability, microvascular injuries, and development of insulin resistance [10]. Besides, the increase in the glomerular filtration rate caused by various mechanisms of tobacco smoke has been noted in association with smoking, i.e., increase in sodium chloride excretion, catecholamine release activation, and increase in vasopressin levels [10][11]. We did not reveal any relation between AU.…”

“…It is a result of the impact of both active and passive smoking on the functional status of the vascular endothelium, endotheliumdependent vasodilation, activation of a series of oxidative stress reactions [9], and antioxidant system suppression [9]. One of the clinical signs of microcirculation disorders among smokers from various age groups [10] is a reliably higher level of albuminuria (AU), an early predictor of microvascular injuries and endothelial dysfunction associated with a high risk of CVD and their complications [9][10][11].…”