Smoking and risk of incident end-stage kidney disease in general population: A Nationwide Population-based Cohort Study from Korea

Hong Sang Choi,Eun Hui Bae,Tae Ryom Oh,Soo Wan Kim,Kyung-Do Han,Seong Kwon Ma,Chang Seong Kim

doi:10.1038/s41598-019-56113-7

Abstract

We analyzed data from the Korean National Health Insurance Service (NHIS) to investigate whether smoking increases the risk of end-stage kidney disease (ESKD). This retrospective nationwide population-based cohort study included the data of 23,232,091 participants who underwent at least one health examination between 2009 and 2012. Smoking status was recorded at baseline. The incidence of ESKD was identified via ICD-10 codes and special medical aid codes from the Korean National Health Insurance Service database till December 2016. A Cox proportional-hazards model with multivariable adjustment was used to evaluate the association between smoking and ESKD incidence. Overall, 24.6% of participants were current smokers; 13.5% and 61.9%, were ex- and non-smokers, respectively. Overall, 45,143 cases of ESKD developed during the follow-up period. Current smokers (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.35–1.43) and ex-smokers (HR, 1.09; 95% CI, 1.06–1.12) demonstrated a significant increase in the adjusted risk of ESKD compared to non-smokers. The risk of ESKD was directly proportional to the smoking duration, number of cigarettes smoked daily, and pack-years. In conclusion, smoking is associated with a greater risk of ESKD in the general Korean population; the risk increases with an increase in the smoking duration, number of cigarettes smoked daily, and pack-years.

Highlights

Smoking is known to be one of the leading causes of preventable deaths worldwide[1,2], with more than seven million deaths caused by tobacco use every year[3]
Ex-smokers showed a significant increase in the risk of end-stage kidney disease (ESKD) compared to never smokers in almost all subgroups. In this retrospective cohort study, we found that smoking was closely associated with an increased risk of incident ESKD cases in the adult general population
These associations interacted with age, sex, Body mass index (BMI), and presence of diabetes, hypertension, chronic kidney disease (CKD), and dyslipidemia

Summary

Introduction

Smoking is known to be one of the leading causes of preventable deaths worldwide[1,2], with more than seven million deaths caused by tobacco use every year[3]. CKD is a growing global public health problem, with an estimated global prevalence of 8–16%9. The prevalence and incidence of end-stage kidney disease (ESKD), which is caused by progression of CKD, differs among different countries and regions. In Korea, the numbers of patients treated with renal replacement therapy are approximately 98,000, and the numbers of new ESKD patients are rapidly increasing every year[10]. Early diagnosis and treatment, and the prevention of CKD by managing risk factors in particular, is becoming an important public health concern. To better understand the association between smoking and adverse renal outcomes in the broader general population, we analyzed nationally representative data from the Korean National Health Insurance System (NHIS)

Methods

Results

Conclusion