Smoking Is Related to Albuminuria and Abnormal Renal Function in Nondiabetic Persons

  1. Sara-Joan Pinto-Sietsma, MD;
  2. Jaap Mulder;
  3. Wilbert M.T. Janssen, MD, PhD;
  4. Hans L. Hillege, MD;
  5. Dick de Zeeuw, MD, PhD; and
  6. Paul E. de Jong, MD, PhD
  1. From University Hospital Groningen and Groningen University Institute for Drug Exploration, Groningen, the Netherlands.

    Abstract

    Background: Smoking induces albuminuria and accelerates progression to renal failure in persons with diabetes, but little is known about the relation between smoking and renal function in nondiabetic persons.

    Objective: To investigate whether smoking is related to albuminuria and abnormal renal function in nondiabetic persons.

    Design: Cross-sectional study.

    Setting: Groningen, The Netherlands.

    Participants: 7476 participants in the PREVEND (Prevention of REnal and Vascular ENd stage Disease) Study.

    Measurements: Microalbuminuria and high normal albuminuria were defined as urinary albumin excretion of 30 to 300 mg/24 h and 15 to 30 mg/24 h, respectively. Elevated or decreased glomerular filtration rate (GFR) was defined as a creatinine clearance that exceeded or was less than two times the standard deviation of the mean value in nondiabetic, nonsmoking participants who had an albumin excretion of 0 to 15 mg/24 h, adjusted for age and sex.

    Results: Current smokers had a higher median albumin excretion than nonsmokers and were more likely to have microalbuminuria and high normal albuminuria with elevated or decreased GFR. After adjustment for several potential confounding factors, persons who smoked 20 or fewer cigarettes/d and persons who smoked more than 20 cigarettes/d, respectively, showed a dose-dependent association between smoking and high normal albuminuria (relative risk, 1.33 [95% CI, 1.10 to 1.61] and 1.98 [CI, 1.49 to 2.64]), microalbuminuria (relative risk, 1.92 [CI, 1.54 to 2.39] and 2.15 [CI, 1.52 to 3.03]), elevated GFR (relative risk, 1.82 [CI, 1.31 to 2.53] and 1.84 [CI, 1.12 to 3.02]), and decreased GFR (relative risk, 1.53 [CI, 1.04 to 2.24] and 1.83 [CI, 1.05 to 3.20]), respectively. Quitting smoking was associated only with microalbuminuria.

    Conclusions: Smoking is associated with albuminuria and abnormal renal function. However, these associations are less pronounced or absent in former smokers.

    Article and Author Information

    • Acknowledgments: The authors thank the research nurses, Roelie Dijkstra-Oppenhuizen and Erika Konneman-van Zalk, for their assistance at the outpatient clinic; Winie G.A. de Jonge-Hovenkamp for secretarial assistance; Dr. Enno van der Veur (General Practitioners Laboratory, Groningen) and Jacko J. Duker (Nephrology Laboratory, University Hospital, Groningen) for laboratory assistance; and Frank P.G. Lambert and Robert J. Bieringa (Trial Coordination Center, Groningen) for data handling.

    • Grant Support: By the Dutch Kidney Foundation (E033).

    • Requests for Single Reprints: Sara-Joan Pinto-Sietsma, MD, Department of Internal Medicine, Division of Nephrology, University Hospital Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.

    • Current Author Addresses: Drs. Pinto-Sietsma, Janssen, and de Jong: Department of Internal Medicine, Division of Nephrology, University Hospital Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.

    • Mr. Mulder and Drs. Hillege and de Zeeuw: Department of Clinical Pharmacology, University Groningen, A. Deusinglaan 1, 9713 AV Groningen, the Netherlands.

    • Author Contributions: Conception and design: S.J. Pinto-Sietsma, W.M.T. Janssen, D. de Zeeuw, P.E. de Jong.

    • Analysis and interpretation of the data: S.J. Pinto-Sietsma, J. Mulder.

    • Drafting of the article: S.J. Pinto-Sietsma.

    • Critical revision of the article for important intellectual content: J. Mulder, W.M.T. Janssen, H.L. Hillege, D. de Zeeuw, P.E. de Jong.

    • Final approval of the article: W.M.T. Janssen, H.L. Hillege, D. de Zeeuw, P.E. de Jong.

    • Statistical expertise: H.L. Hillege.

    • Obtaining of funding: D. de Zeeuw, P.E. de Jong.

    • Collection and assembly of data: S.J. Pinto-Sietsma.

    Summary for Patients

    • Summaries for Patients:Smoking and Kidney Function in Persons without Diabetes Ann Intern Med October 17, 2000 133:I-33
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    1. Ann Intern Med October 17, 2000 vol. 133 no. 8 585-591
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