Association between Cigarette Smoking and Chronic Kidney Disease in Japanese Men

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Abstract
Cigarette smoking may affect urinary albumin excretion and the glomerular filtration rate in both diabetic and nondiabetic subjects. Here we investigated the association between smoking and decreased or elevated glomerular filtration rate (GFR) and albuminuria by analyzing data from 7,078 Japanese men who had undergone a general health screening between 2005 and 2006. GFR was estimated with the Modified Diet in Renal Disease (MDRD) equation, and low estimated GFR (eGFR) and elevated eGFR were defined, respectively, as eGFR 90.7 mL/min/1.73 m2. Albuminuria was considered present when the urinary albumin excretion ratio (UAER), expressed as mg/g creatinine, was ≥30 mg/g. Multivariate logistic regression analysis showed that current smoking was associated inversely with low eGFR, and positively with albuminuria and elevated eGFR. The association between current smoking and low or elevated GFR was dependent on the number of cigarettes smoked per day. Former smoking was also significantly inversely associated with low eGFR, but the association between former smoking and albuminuria or elevated eGFR was not significant, even in individuals who had stopped smoking less than 1 year before. These data suggest that cigarette smoking may increase the prevalence of albuminuria and elevated eGFR or hyperfiltration, traits that might be reversed by smoking cessation. Although this concept should be verified by future longitudinal studies, our data suggest that we may need to take into account an individual's smoking status when assessing the presence or absence of chronic kidney disease because cigarette smoking may transiently increase eGFR.