Pediatric Nephrology

, Volume 28, Issue 8, pp 1243–1251 | Cite as

Secondhand smoke exposure is associated with proteinuria in children with chronic kidney disease

  • Abiodun Omoloja
  • Judith Jerry-Fluker
  • Derek K. Ng
  • Alison G. Abraham
  • Susan Furth
  • Bradley A. Warady
  • Mark Mitsnefes
Original Article



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.


Proteinuria 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.


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Copyright information

© IPNA 2013

Authors and Affiliations

  • Abiodun Omoloja
    • 1
  • Judith Jerry-Fluker
    • 2
  • Derek K. Ng
    • 2
  • Alison G. Abraham
    • 2
  • Susan Furth
    • 3
  • Bradley A. Warady
    • 4
  • Mark Mitsnefes
    • 5
  1. 1.Department of PediatricsWright State UniversityDaytonUSA
  2. 2.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  4. 4.Children’s Mercy HospitalKansas CityUSA
  5. 5.Cincinnati Children’s Hospital Medical CenterCincinnatiUSA

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