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Clin J Am Soc Nephrol. 2019 Apr 5;14(4):515-522. doi: 10.2215/CJN.09540818. Epub 2019 Mar 7.

Secondhand Smoke and CKD.

Author information

Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea.
Institute of Kidney Disease Research and.
Department of Internal Medicine, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea.
Brain Korea 21 PLUS, Severance Biomedical Science Institute, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea; and.
Institute of Kidney Disease Research and



Active smoking is associated with higher risk of various diseases. However, the risk of CKD development in nonsmokers exposed to secondhand smoke is not well elucidated. We aimed to investigate the association between secondhand smoke exposure and the risk of CKD development among never-smokers.


A total of 131,196 never-smokers with normal kidney function, who participated in the Korean Genome and Epidemiology Study from 2001 to 2014, were analyzed. The participants were classified into three groups on the basis of frequency of secondhand smoke exposure, assessed with survey questionnaires; no exposure, <3 days per week, and ≥3 days per week. The association between secondhand smoke and CKD, defined as eGFR<60 ml/min per 1.73 m2, was examined in the cross-sectional analysis. In addition, the risk of incident CKD development was analyzed in a longitudinal cohort of 1948 participants without CKD at baseline, which was a subset of the main cohort.


The mean age of participants was 53 years, and 75% were women. Prevalent CKD was observed in 231 (1.8%), 64 (1.7%), and 2280 (2.0%) participants in the ≥3 days per week, <3 days per week, and no exposure groups. The odds ratio (OR) of prevalent CKD was significantly higher in the groups exposed to secondhand smoke than the no exposure group (<3 days per week: OR, 1.72; 95% confidence interval [95% CI], 1.30 to 2.27; and ≥3 days per week: OR, 1.44; 95% CI, 1.22 to 1.70). During a mean follow-up of 104 months, CKD occurred in 319 (16%) participants. Multivariable Cox analysis revealed that the risk for CKD development was higher in participants exposed to secondhand smoke than the no exposure group (<3 days per week: hazard ratio, 1.59; 95% CI, 0.96 to 2.65; and ≥3 days per week: hazard ratio, 1.66; 95% CI, 1.03 to 2.67).


Exposure to secondhand smoke was associated with a higher prevalence of CKD as well as development of incident CKD.


Confidence Intervals; Cross-Sectional Studies; Epidemiologic Studies; Follow-Up Studies; Odds Ratio; Prevalence; Renal Insufficiency, Chronic; Risk; Smokers; Smoking; Tobacco Smoke Pollution; chronic kidney disease; clinical epidemiology; glomerular filtration rate; risk factors


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