Table 3. The Effects of Smoking on Renal Function in Healthy Populations .
| Authors | Year | Study Design (LOE) | Main Outcomes | Qualitya / Commentb |
|---|---|---|---|---|
| Goetz FC, et al.(14) | 1997 | 5-yr follow up in 455 adults in a U.S. community (II;a) | Mean Ccr was significantly higher in current smokers than in ex- and never smokers adjusted for age, gender, BMI, BP and DM. Decline of Ccr during 5 years was significantly greater in current and ex-smokers than in never smokers adjusted for the confounders. | c/ Small number of subjects |
| Pinto-Sietsma SJ,et al.(21) | 2000 | Cross-sectional in 7,476 adults in a Dutch community (III) | OR for elevated eGFR (>Mean+2SD) in current smokers consuming up to 20 cigarettes per day and in those consuming more vs. never smokers was 1.82 (1.31~2.53) and 1.84 (1.12~3.02) respectively adjusted for age, gender, BMI, BP, PG and alcohol. OR for decreased eGFR (<Mean-2SD) in current smokers consuming up to 20 cigarettes per day and in those consuming more vs. never smokers was 1.53 (1.04~2.24) and 1.83 (1.05~3.20) respectively adjusted for the confounders. | A |
| Halimi JM,et al.(15) | 2000 | Cross-sectional in 28,409 French participants in health screening (III) | Mean Ccr estimated by CG formula in current smokers was significantly higher than those in former and never smokers adjusted for age, gender and BMI. No difference in the age-related decline of Ccr among current, former and never smokers. | B/ Ccr was estimated by CG formula |
| Bleyer AJ,et al.(28) | 2000 | 3-yr follow up in 4,142 inhabitants in a U.S. community aged 65 years or older (IIb) | OR for increase in serum Cr concentration (≧ 0.3 mg/dl) in current smoker vs. never smokers was 2.10 (1.4~3.1) adjusted for age, gender and body weight. | C/ Short period of observation |
| Briganti EM,et al.(12) | 2002 | Population-based Case-control study in 11,247 adults in a Australian community (III) | OR for low eGFR (<60 ml/min/1.73 m2) estimated by CG formula in male current smokers was Ex-smoking was 3.59 (1.27~10.09), but 0.90 (0.39~2.06) in female not considered smokers in comparison with nonsmokers adjusted for age, BMI, BP and FPG. | C |
| Haroun MK,et al.(33) | 2003 | 20-yr follow up in 23,534 men and women in a U.S. community (IIa) | HR for incident ESRD or death due to kidney disease in male and female current smokers vs. nonsmokers was 2.4 (1.5~4.0) and 2.9 (1.7~5.0) respectively adjusted for age, DM and BP. | C/ Not excluding mild CKD patients at the baseline |
| Fox CS,et al.(30) | 2004 | 18.5-yr follow up in 1,223 men and 1,362 women in a U.S. community (IIa) | OR for incident low eGFR(≦ 59.25 ml/min/1.73 m2 in women and ≦ 64.25 ml/min/1.73 m2in men) was 1.42 (1.06~1.91) in current smokers vs. nonsmokers adjusted for age, gender, BMI, DM and hypertension | C/ Ex-smoking was not considered |
| Ejerblad E,et al.(29) | 2004 | Population-based case-control study (926 CRF cases) in a Swedish community (III) | OR for CRF (serum Cr level ≧ 3.4 mg/dl in men and≧2.8 mg/dl in women) in smokers consuming 16-30 pack-years of cigarettes and in those consuming more vs. never smokers was 1.32 (1.00~1.75) and 1.52 (1.08~2.14) respectively adjusted for age, gender, alcohol, education and the use of analgesics. | B/ Renal function was evaluated only by serum Cr level |
| Baggio B,et al.(27) | 2005 | 3.6-yr follow up in 1,283 men and 1,147 women in a Italian community aged 65-84 years (IIa) | OR for increase in serum Cr concentration (≧26.5μmole/l)was 2.29 (1.00~5.27) in current smokers consuming 20 cigarettes per day or more vs.never smokers adjusted for age, DM, hypertension and high plasma fibrinogen. | B/ Renal function was evaluated only by serum Cr level |
| Hallan S,et al.(31) | 2006 | Cross-sectional in 30,485 males and 34,708 females 34,708 females in a Norwegian community (III) | OR for CKD (eGFR<45 ml/min/1.73 m2) in smokers consuming 25-49 pack-years of cigarettes and in those consuming more was 1.42(1.00~2.00) and 2.05 (1.08~3.89) respectively adjusted for age and gender. | B/ Not excluding DM patients |
| Shankar A,et al.(37) | 2006 | 5-yr follow up in 3,392 inhabitants aged 43-84 years in a U.S. community (IIa) | Cross-sectional phase: OR for CKD (eGFR<60 ml/min/1.73 m2) in smokers consuming 15-34 pack-years of cigarettes and in those consuming more was 2.57 (1.79~3.70) and 2.93 (2.08~4.12) respectively adjusted for age, gender, BMI, education, DM and hypertension. Follow up phase: OR for incident CKD in current smokers vs. never smokers was 1.97 (1.15~3.36) adjusted for the confounders. | B/ Not excluding DM patients |
| Yamagata K,et al.(38) | 2007 | 10-yr follow up in 41,012 men and 82,752 women aged 40 years or older in a Japanese community (IIa) | OR for incidence of stage 1 and 2 CKD in current smokers was 1.26 (1.14~1.41) in men and 1.40(1.16~1.69) in women adjusted for age, obesity,DM, hypertension, hyperlipidemia and alcohol. OR for incidence of stage 3 CKD in current smokers was 1.13 (1.05~1.22) in men and 1.16 (1.06~1.26) in women adjusted for the confounders. | B/ Not excluding DM patients |
| Noborisaka Y,et al.(36) | 2007 | Cross-sectional in 2,133 male Japanese workers (III) | Mean Ccr estimated by CG formula was significantly higher in current smokers than in former and never smokers adjusted for age and BMI. | C/ Ccr was estimated by CG formula |
| Zhang L,et al.(26) | 2008 | Cross-sectional in 13,925 adults in communities in China (III) | OR for low eGFR (<60 ml/min/1.73 m2) was 1.15 (0.79~1.68) in current smokers vs. non-smokers adjusted for age, gender, obesity, DM, hypertension and hyperlipidemia. | B/ Ex-smoking was not considered |
| Kronborg J,et al.(34) | 2008 | 7-yr follow up in 2,249 men and 2,192 women in a Norwegian community (IIa) | Current female smokers showed a signifcantly larger increase in eGFR during 7 years as compared with never smokers adjusted for age, WC,BP, DM, alcohol and physical activity, while male smokers did not. | B/ Not excluding DM patients |
| Ishizaka N,et al.(17) | 2008 | Cross-sectional in 7,078 Japanese male participants in health screening (III) | OR for low eGFR (<60 ml/min/1.73 m2) in current smokers consuming 20-39 cigarettes per day and those consuming more was 0.63 (0.49~0.83) and 0.32 (0.13~0.79) respectively adjusted for age, SBP and FPG. OR for high eGFR (> 90.73 ml/min/1.73 m2) | B/ Not excluding DM patients |
| Yoon HJ,et al.(25) | 2009 | Cross-sectional in 35,228 Korean participants in a health screening program (III) | Mean eGFR was significantly higher in current smokers than in former and never smokers. In the subjects showing a low eGFR (<50 ml/min/1.73 m2), current smokers showed lower eGFR than former and never smokers. OR for incident low eGFR (<60 ml/min/1.73 m2) in current smokers consuming up to 20 cigarettes and in those consuming more was 0.76 (0.62~0.94) and 0.73 (0.60~0.90) respectively adjusted for age, BMI, BP and FPG. | A |
| Sauriasari R,et al.(22) | 2010 | Cross-sectional in 290 male and 359 female Japanese participants in health screening (IIIa) | OR for high eGFR (≧96.7 ml/min/1.73 m2) in smokers consuming less than 20 pack-years and in those consuming more vs. never smokers was 1.08 (0.59~1.98) and 2.38 (1.15~4.93) respectively adjusted for age, gender, BMI and BP. | C/ Small number of subjects |
| Miyatake N,et al.(35) | 2010 | 5-yr follow up in 286 male Japanese workers (IIa) | Reduction of eGFR during 5 years was signifcantly smaller in 145 current smokers than in 141 nonsmokers. | C/ Small number of subjects |
| Hallan SI, Orth SR(32) | 2011 | 10-yr (median) follow up in 65,589 adults from a community in Norway (IIa) | HR for the incidence of stage 5 CKD in former and current male smokers was 3.74(1.05~13.2) and 5.75(1.46~22.6), respectively, as compared to never-smokers. HR was 3.19(0.76~13.5) and 2.77(0.64~11.9), respectively, in females. Cessation of smoking significantly reduced the incidence of stage 5 CKD dependently to the lapsed years from the cessation. | C/ Not excluding mild CKD patients at the baseline |
| Noborisaka Y, et al.(7) | 2011 | Cross-sectional in 990 middle-aged Japanese men from a chemical plant (III) | Mean eGFR was significantly higher in current smokers than in former and never smokers. Normal but high eGFR (≧110 ml/min/1.73 m2) was 6.7% in current heavy smokers and subnormal eGFR (< 60 ml/min/1.73 m2) was 5.7% in those with a BI of 600 or higher while both were 3.0% or less in never-smokers, although the differences between smokers and non-smokers were not significant. | A |
Abbreviations: BI, Brinkman Index; BP, blood pressure; BMI, body mass index; Ccr, creatinine clearance; CG formula, Cockcroft and Gault formula; Cr, creatinine; DM, diabetes mellitus; ESRD, end stage renal disease; FPG, fasting plasma glucose; HR: hazard ratio, LOE, level of evidence defined by AHCPR (1993), OR: odds ratio
aQuality: For the definition, refer to text and Table 1.
bComment: The main reason for grading the article as B or C.