Tobacco and Kidney Function in Adolescents

Abstract

Research Article| July 01 2013 Tobacco and Kidney Function in Adolescents AAP Grand Rounds (2013) 30 (1): 9. https://doi.org/10.1542/gr.30-1-9 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Tobacco and Kidney Function in Adolescents. AAP Grand Rounds July 2013; 30 (1): 9. https://doi.org/10.1542/gr.30-1-9 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: renal function, tobacco, smoke, smoking, passive smoking Source: Garcia-Esquinas E, Loeffler L, Weaver V. Kidney function and tobacco smoke exposure in US adolescents [published online ahead of print April 8, 2013]. Pediatrics. doi: https://doi.org/10.1542/peds.2012-3201 Investigators from Johns Hopkins University and 2 institutions in Spain conducted a cross-sectional study of adolescents 12 to 17 years of age to determine if there is an association between active smoking or secondhand smoke (SHS) and kidney function. The investigators utilized data from the 2009–2010 National Health and Nutrition Examination Survey (NHANES), a nationally representative population survey administered by the Centers for Disease Control and Prevention (CDC). Participants were classified as active smokers based on self-report by questionnaire or serum cotinine concentration over 10 ng/ml. SHS exposure was defined as either a nonactive smoker by self-report who lived with at least 1 person who smoked, or a nonactive smoker who had serum cotinine levels ≥0.05 ng/ml but ≤10 ng/ml. Adolescents were classified as unexposed to tobacco based on self-report and verified by a cotinine level <0.05 ng/ml. Kidney function (eGFR) was estimated from serum creatinine measurements. The investigators examined the relationship between smoke exposure and eGFR after accounting for the influence of age, gender, ethnicity, BMI, parental education, and NHANES year. A total of 7,516 adolescents were identified who had available data on creatinine and serum cotinine levels, of whom 12% were active smokers and 49% were exposed to SHS. The median eGFR was 90.1 ml/min per 1.73 m2 among active smokers, 96.8 ml/min per 1.73 m2 among participants exposed to SHS, and 99.1 ml/min per 1.73 m2 among unexposed participants. In multivariate models, eGFR decreased 1.1 ml/min per 1.73 m2 (95% CI, −1.8 to −0.3) for every inter-quartile range increase in serum cotinine among all participants. Compared to the unexposed group, the mean differences in eGFR for active smokers stratified by cotinine level tertiles were 0.2, −1.9, and −2.6 ml/min per 1.73 m2, respectively (P = .01). Similarly, compared to unexposed adolescents, for those in the SHS group the mean difference in eGFR by cotinine tertiles were −0.4, −0.9, and −2.2 ml/min per 1.73 m2, respectively (P =.03). The authors conclude that there is an association between tobacco smoke exposure and decreased kidney function in a nationally representative population of adolescents in the United States. Dr Sethna has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Although there have been significant strides in tobacco control in recent years, cigarette smoking and SHS exposure continue to be national public health problems that affect children and adolescents. Tobacco, with the active ingredient nicotine, has been linked to the pathogenesis of many diseases and many untoward health effects. In the adult population, there is evidence that cigarette smoking is an independent risk factor for the development and progression of chronic kidney disease and kidney transplant failure.1,2 Studies in children and adolescents have been... You do not currently have access to this content.