Editorials

Adverse effect of smoking on renal function in the general population: Are men at higher risk?*

Racial differences in rapid kidney function decline exist, but less is known regarding factors associated with rapid decline among African Americans. Greater understanding of potentially modifiable risk factors for early kidney function loss may help reduce the burden of kidney failure in this high-risk population.

Prospective cohort study.

3,653 African American participants enrolled in the Jackson Heart Study (JHS) with kidney function data from 2 of 3 examinations (2000-2004 and 2009-2013). Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine using the CKD-EPI creatinine equation.

Demographics, socioeconomic status, lifestyle, and clinical risk factors for kidney failure.

Rapid decline was defined as a ≥30% decline in eGFR during follow-up. We quantified the association of risk factors with rapid decline in multivariable models.

Clinical (systolic blood pressure and albuminuria [albumin-creatinine ratio]) and modifiable risk factors.

Mean age was 54 ± 12 (SD) years, 37% were men, average body mass index was 31.8 ± 7.1 kg/m², 19% had diabetes mellitus (DM), and mean eGFR was 96.0 ± 20 mL/min/1.73 m² with an annual rate of decline of 1.27 mL/min/1.73 m². Those with rapid decline (11.5%) were older, were more likely to be of low/middle income, and had higher systolic blood pressures and greater DM than those with nonrapid decline. Factors associated with ≥30% decline were older age (adjusted OR per 10 years older, 1.51; 95% CI, 1.34-1.71), cardiovascular disease (adjusted OR, 1.53; 95% CI, 1.12-2.10), higher systolic blood pressure (adjusted OR per 17 mm Hg greater, 1.22; 95% CI, 1.06-1.41), DM (adjusted OR, 2.63; 95% CI, 2.02-3.41), smoking (adjusted OR, 1.60; 95% CI, 1.10-2.31), and albumin-creatinine ratio > 30 mg/g (adjusted OR, 1.55; 95% CI, 1.08-1.21). Conversely, results did not support associations of waist circumference, C-reactive protein level, and physical activity with rapid decline.

No midstudy creatinine measurement at examination 2 (2005-2008).

Rapid decline heterogeneity exists among African Americans in JHS. Interventions targeting potentially modifiable factors may help reduce the incidence of kidney failure.

Le tabagisme reste un problème majeur de santé publique. Il est associé à un nombre considérable de décès dans la population mondiale. Fumer est au même titre que l’hypertension artérielle, un facteur indépendant de progression pour toute néphropathie primaire ainsi que chez le transplanté rénal. Il semble que l’arrêt du tabac ralentit la progression de l’insuffisance rénale chez les fumeurs. Les données de la littérature sont parfois à ce sujet contradictoires en raison de certaines faiblesses méthodologiques. En revanche, les modèles expérimentaux mettent en lumière les effets néfastes du tabac par des facteurs hémodynamiques et non hémodynamiques. La conclusion est qu’un effort important supplémentaire doit être produit par la communauté néphrologique afin de motiver nos patients de cesser de fumer.

Smoking remains a major public health problem. It is associated with a considerable number of deaths in the world's population. Smoking is just like high blood pressure, an independent predictor of progression to any primary renal disease and renal transplant patients. It seems that smoking cessation slows the progression of kidney disease in smokers. The literature data are sometimes contradictory about it because of some methodological weaknesses. However, experimental models highlight the harmful effects of tobacco by hemodynamic and non-hemodynamic factors. The conclusion is that a major effort should be further produced by the nephrology community to motivate our patients to stop smoking.