Cigarette Smoking Associated with Chronic Kidney Disease in African Americans

by | Jun 29, 2020 | 2016, Kidney Health, Tobacco

Written by Joyce Smith, BS. This study found an independent association for current smokers between cigarette smoking and rapid renal function decline in African American participants, particularly among current smokers who smoke over 20 cigarettes per day. 

health hazardsAfrican Americas, due to their propensity for higher rates of hypertension, obesity,  and diabetes, 1  experience a four times greater risk of developing end-stage renal disease 2. Abundant evidence suggests that cardiovascular and kidney diseases are closely linked but the potential adverse impact of cigarette smoking on renal function is not well understood.  Thus, Michael Hall and colleagues 3 sought to evaluate the renal function decline in a large cohort of 3,648 African American men and women, ages 21 to 84, who were participants in the Jackson Heart Study from 2000 through to 2004. To assess renal function, the team collected blood and urine specimens at baseline to determine serum creatinine levels and glomerular filtration rates. The rate of rapid renal function (RRF) decline was defined as the absolute decline of estimated glomerular filtration rate of 30% from visit 1 to visit 3 among the participants.

Data analysis included 3,648 out of a total of 5,302 participants who had creatinine measures done at Visit 1 and Visit 3.  At visit 1, researchers classified 422 participants as current smokers, 659 as past smokers, and 2,567 as never smokers. They found that, compared to past smokers, current smokers were more likely to be male and more likely to  have lower a lower body mass index (BMI), lower rates of hypertension and diabetes, consumed less alcohol and had less physical exercise (P<0.001for all ) compared to past smokers.

After adjusting for age, gender, body mass index, diabetes, hypertension, cholesterol, physical activity, education, alcohol consumption, and prevalent cardiovascular disease, those who smoked had a significantly higher rate of kidney decline compared to those who never smoked. Those who smoked  up to 19 or more than 20 cigarettes daily had a 75% and 97% greater increased rate of RRF decline (incidence rate ratios of 1.75 [95% CI 1.18–2.59] and 1.97 [95% CI 1.17–3.31]), respectively than those who never smoked. There was also a significant, progressive reduction in estimated glomerular filtration rate from visit 1 to visit 3 in current and past smokers compared with never smokers. In addition, after controlling for covariates current smokers had a 1.38-fold increase in C-reactive protein (reflecting a 38% higher level of inflammation) compared with never smokers.

This study links cigarette smoking to increased inflammation and builds on previous studies that imply a role for increased oxidative stress, endothelial dysfunction and atherogenesis in kidney dysfunction 4-6. Since 17.5% of African Americans smoke less cigarettes than other ethnic groups, they metabolize the substances in cigarettes differently 7. For example, menthol cigarettes are an African American favorite 8,9 that have been linked to increased blood cadmium concentrations, which even in low concentrations are associated with renal tubular damage 10.

Study limitations include the inability to analyze the cigarette types used in this study. Also, a true measure of rate of renal glomerular filtration was difficult to achieve 11. In addition, these results may not be generalized to other ethnic groups; however, the study does demonstrate that cigarette smoking among African Americans is independently, and in a dose-dependent manner, associated with RRD decline and that increased inflammation may potentiate the mechanisms involved.

Source: Hall, Michael E., Wei Wang, Victoria Okhomina, Mohit Agarwal, John E. Hall, Albert W. Dreisbach, Luis A. Juncos et al. “Cigarette smoking and chronic kidney disease in African Americans in the Jackson Heart Study.” Journal of the American Heart Association 5, no. 6 (2016): e003280.

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Posted June 29, 2020.

Joyce Smith, BS, is a degreed laboratory technologist. She received her bachelor of arts with a major in Chemistry and a minor in Biology from  the University of Saskatchewan and her internship through the University of Saskatchewan College of Medicine and the Royal University Hospital in Saskatoon, Saskatchewan. She currently resides in Bloomingdale, IL.

References:

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