Abstract P025: Cigarette Smoking And Risk Of Hospitalization With Acute Kidney Injury: The Atherosclerosis Risk In Communities (aric) Study

Abstract

Title: Cigarette smoking and risk of hospitalization with acute kidney injury: The Atherosclerosis Risk in Communities (ARIC) Study Background: Smoking has been associated with progression of chronic kidney disease. However, its association with the development of acute kidney injury (AKI) has not been prospectively assessed in the community. AKI poses significant morbidities and healthcare costs, thus understanding modifiable risk factors of AKI is crucial. Methods: Among 14,587 participants (mean age 54 [standard deviation: 6] years, 55% females and 25.4% Blacks) from the Atherosclerosis Risk in Communities Study, we quantified the association of smoking status with incident hospitalization with AKI (AKI diagnosis on discharge records in any diagnostic position) through 2019 using Cox models. Sensitivity analyses included censoring interim CVD events during follow-up and restricting to AKI as the primary diagnosis. Results: Over a median follow-up of 26.3 years, 2,986 participants had incident hospitalization with AKI (incidence rate per 1,000 person-years: 8.8; 95% CI: 8.4-9.1). In multivariable Cox models, current smokers had a >2-fold higher risk of AKI compared with never smokers (HR: 2.25; 95% CI: 2.04-2.48) (Table). There was a dose-response relationship between smoking pack-years at baseline and risk of AKI (e.g., HRs 1.34 [1.21, 1.50] with 10-25 pack-years, 1.78 [1.59, 1.99] with 25-40 pack-years, and 2.03 [1.80-2.29] with ≥40 pack-years vs. never smokers). These associations were consistent with similar HRs in the two sensitivity analyses censoring interim cardiovascular diseases and analyzing AKI as the primary cause of hospitalization (Table). Conclusions: In a community-based cohort, smoking was associated with the risk of incident hospitalization with AKI, which was independent of potential confounders and robust in a few sensitivity analyses. These results suggest the importance of smoking cessation to reduce the risk of AKI.