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Clin J Am Soc Nephrol. 2018 Jul 6;13(7):993-1001. doi: 10.2215/CJN.11121017. Epub 2018 Jun 7.

Self-Reported Tobacco, Alcohol, and Illicit Drug Use and Progression of Chronic Kidney Disease.

Author information

1
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
2
Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
3
Department of Medicine, University of Illinois, Chicago, Illinois.
4
Division of Nephrology, Case Western Reserve University, Cleveland, Ohio.
5
Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
6
Division of Nephrology, University of California San Francisco, San Francisco, California.
7
Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, Michigan.
8
Division of Nephrology, St. John Hospital and Medical Center, Detroit, Michigan; and.
9
Division of Nephrology, University of Michigan School of Medicine, Ann Arbor, Michigan.
10
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; jhe@tulane.edu.

Abstract

BACKGROUND AND OBJECTIVES:

Previous studies suggest that tobacco, alcohol, and illicit drug use is associated with CKD. We examined the associations of substance use with CKD progression and all-cause mortality among patients with CKD.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

The Chronic Renal Insufficiency Cohort Study is a prospective, longitudinal cohort study among 3939 participants with CKD in the United States. Self-reported tobacco smoking, alcohol drinking, marijuana use, and hard illicit drug (cocaine, heroin, or methamphetamine) use were obtained at baseline and annual follow-up visits. CKD progression was defined as incident ESKD or halving of eGFR. Substance use was modeled as the cumulative average exposure to capture both recent and long-term use in multivariable time-dependent Cox regression.

RESULTS:

Over a median 5.5-year follow-up, 1287 participants developed CKD progression, and 1001 died. Baseline proportions of tobacco smoking, alcohol drinking, marijuana use, and hard illicit drug use were 13%, 20%, 33%, and 12%, respectively. Compared with nonsmoking throughout follow-up, multivariable-adjusted hazard ratios for persistent tobacco smoking were 1.02 (95% confidence interval, 0.86 to 1.21) for CKD progression and 1.86 (95% confidence interval, 1.54 to 2.24) for all-cause mortality. Compared with nondrinking throughout follow-up, multivariable-adjusted hazard ratios for persistent alcohol drinking were 1.06 (95% confidence interval, 0.88 to 1.29) for CKD progression and 0.73 (95% confidence interval, 0.58 to 0.91) for all-cause mortality. Compared with nonuse throughout follow-up, multivariable-adjusted hazard ratios for persistent marijuana use were 0.94 (95% confidence interval, 0.82 to 1.07) for CKD progression and 1.11 (95% confidence interval, 0.96 to 1.30) for all-cause mortality. Compared with nonuse throughout follow-up, multivariable-adjusted hazard ratios for persistent hard illicit drug use were 1.25 (95% confidence interval, 1.00 to 1.55) for CKD progression and 1.41 (95% confidence interval, 1.10 to 1.81) for all-cause mortality.

CONCLUSIONS:

Hard illicit drug use is associated with higher risk of CKD progression and all-cause mortality, tobacco smoking is associated with higher risk of all-cause mortality, and alcohol drinking is associated with lower risk of all-cause mortality among patients with CKD.

KEYWORDS:

Alcohol Drinking; Cocaine; Confidence Intervals; Disease Progression; Epidemiology and outcomes; Follow-up Studies; Heroin; Humans; Kidney Failure, Chronic; Marijuana Use; Methamphetamine; Prospective Studies; Renal Insufficiency, Chronic; Self Report; Street Drugs; Tobacco Smoking; chronic kidney disease; glomerular filtration rate; mortality; progression of chronic renal failure; risk factors

PMID:
29880471
PMCID:
PMC6032576
[Available on 2019-07-06]
DOI:
10.2215/CJN.11121017

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