Secondhand smoke exposure is associated with proteinuria in children with chronic kidney disease
- 410 Downloads
In adults with chronic kidney disease (CKD), cigarette smoking is associated with an increased risk for CKD progression and transplant failure. In children, secondhand smoke (SHS) exposure has been associated with elevated blood pressure. There are no studies on the prevalence and effect of SHS exposure in CKD.
Subjects were enrolled in the Chronic Kidney Disease in Children (CKiD) Study, an observational cohort of 366 children aged 1 to 16 years with CKD. Secondhand smoke exposure was obtained via questionnaire. SHS exposure was also determined based on urine cotinine (Ucot) measurements (1 ng/mL ≤ Ucot < 75 ng/mL). The cross-sectional association of SHS exposure with proteinuria was assessed.
Using Ucot, 22 % of subjects were exposed to SHS. SHS exposure was significantly associated with lower maternal education and African American race, and a greater prevalence of nephrotic range proteinuria and left ventricular hypertrophy. In a multivariate model (including sex, age, race, maternal education, income level, private insurance status, abnormal birth history and CKD diagnosis), the prevalence odds of nephrotic range proteinuria was 2.64, (95 % confidence interval 1.08, 6.42) higher in children exposed to SHS compared to those unexposed.
In our cohort of children with CKD, SHS exposure was common (22 %) and independently associated with nephrotic range proteinuria. Exposure to SHS may be an important factor to consider in CKD progression.
KeywordsProteinuria Tobacco use Chronic kidney disease progression Secondhand smoke exposure Urine cotinine Pediatric chronic kidney disease
We would like to acknowledge the assistance of Adrienne Stolfi in the conceptualization of the project. CKiD is funded by the NIDDK, with additional funding from NINDS, NICHD and NHLBI (U01-DK-66143, U01-DK-66174, and U01-DK-66116). The Clinical Pharmacology Laboratory at the University of California San Francisco receives support from the NIH (S10 RR026437 and P30 DA012393). Funding for urine cotinine and creatinine evaluation was provided by the Research Foundation of Dayton Children’s Medical Center, Dayton, Ohio, USA.
- 12.Omoloja A, Chand D, Greenbaum L, Wilson A, Bastian V, Ferris M, Bernert J, Stolfi A, Patel H (2010) Cigarette smoking and second-hand smoking exposure in adolescents with chronic kidney disease: a study from the Midwest pediatric nephrology consortium. Nephrol Dial Transplant 26:908–913CrossRefPubMedGoogle Scholar
- 18.Furth SL, Cole SR, Moxey-Mims M, Kaskel F, Mak R, Schwartz G, Wong C, Muñoz A, Warady BA (2006) Design and methods of the chronic kidney disease in children (CKiD) prospective cohort study. Clin J Am Soc Nephrol 1:1006–1015Google Scholar
- 20.Bernert JT Jr, Turner WE, Pirkle JL, Sosnoff CS, Akins JR, Waldrep MK, Ann Q, Covey TR, Whitfield WE, Gunter EW, Miller BB, Patterson DG Jr, Needham LL, Hannon WH, Sampson EJ (1997) Development and validation of sensitive method for determination of serum cotinine in smokers and nonsmokers by liquid chromatography/atmospheric pressure ionization tandem mass spectrometry. Clin Chem 43:2281–2291PubMedGoogle Scholar
- 21.U.S. Department of Health and Human Services (2006) The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and HealthGoogle Scholar
- 26.Soergel M, Kirschstein M, Busch C, Danne T, Gellermann J, Holl R, Krull F, Reichert H, Reusz GS, Rascher W (1997) Oscillometric twenty-four-hour ambulatory blood pressure values in healthy children and adolescents: a multicenter trial including 1141 subjects. J Pediatr 130:178–184CrossRefPubMedGoogle Scholar
- 27.Urbina E, Alpert B, Flynn J, Hayman L, Harshfield GA, Jacobson M, Mahoney L, McCrindle B, Mietus-Snyder M, Steinberger J, Daniels S, American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee (2008) Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment: a scientific statement from the American heart association atherosclerosis, hypertension, and obesity in youth committee of the council on cardiovascular disease in the young and the council for high blood pressure research. Hypertension 52:433–451CrossRefPubMedGoogle Scholar