Smoking as a risk factor for end-stage renal failure in men with primary renal disease

• Published in: Kidney international Vol. 54; no. 3; pp. 926 - 931
• Main Authors: Orth, Stephan R., Stöckmann, Axel, Conradt, Christian, Ritz, Eberhard, Ferro, M., Kreusser, W., Piccoli, G., Rambausek, M., Roccatello, D., Schäfer, K., Sieberth, H.G., Wanner, C., Watschinger, B., Zucchelli, P.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-09-1998; Nature Publishing
• Subjects: ACE inhibitors; Adult; Aged; Biological and medical sciences; Case-Control Studies; dialysis; end-stage renal failure; Female; Humans; hypertension; Kidney Diseases - complications; Kidney Failure, Chronic - etiology; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; progression; Regression Analysis; Renal failure; Retrospective Studies; Risk Factors; Smoking - adverse effects; tobacco; dialysis; progression; end-stage renal failure; tobacco; ACE inhibitors; hypertension; Human; Kidney disease; Glomerulonephritis; Immunopathology; IgA; Urinary system disease; Polycystic kidney; Tobacco smoking; Male; Genetic disease; Chronic; Cyst; Risk factor; Renal failure; Adult; Complication; Benign neoplasm
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1046/j.1523-1755.1998.00067.x

Smoking as a risk factor for end-stage renal failure in men with primary renal disease.
It is not known whether smoking increases the risk of end-stage renal failure (ESRF) in patients with primary renal disease.
We performed a retrospective multicenter case-control study including 582 patients from nine centers in Germany, Italy and Austria. The diseases investigated were IgA glomerulonephritis (IgA-GN) as a model of inflammatory renal disease and autosomal dominant polycystic kidney disease (ADPKD) as a model of non-inflammatory renal disease. Cases were patients who had progressed to ESRF and controls were patients who were not in ESRF, that is, whose serum-creatinine failed to progress to >3mg/dl during the observation period and who did not require renal replacement therapy. Matching for renal disease (IgA-GN, ADPKD), gender, age at renal death and region of residence resulted in 102 individually matched pairs (IgA-GN N = 54, ADPKD N = 48). Multiple conditional logistic regression was used to estimate adjusted odds ratios for independent tobacco effects.
In men (matched pairs: IgA-GN N = 44, ADPKD N = 28), a significant dose-dependent increase of the risk to progress to ESRF was found (non-adjusted). The baseline risk was defined as <5 pack-years (PY): (i) 5 to 15 PY, odds ratio 3.5 (95% CI 1.3 to 9.6), P = 0.017; (ii) >15 PY = 5.8 (2.0 to 17), P = 0.001. Systolic blood pressure, ACE inhibitor treatment and age at diagnosis emerged as potential confounders. After adjustment, the risk for ESRF in men with >5 PY was highly increased for patients without ACE inhibitor treatment [10.1 (2.3 to 45), P = 0.002] but not with ACE inhibitor treatment [1.4 (0.3 to 7.1), P = 0.65].
Smoking increases the risk of ESRF in men with inflammatory and non-inflammatory renal disease.