Kidney Res Clin Pract. 2025 Sep 9. doi: 10.23876/j.krcp.24.292. Online ahead of print.
ABSTRACT
BACKGROUND: Chronic kidney disease (CKD) is a growing global health challenge, with smoking identified as a significant risk factor. This study investigates the long-term impact of adolescent smoking initiation on end-stage kidney disease (ESKD) development.
METHODS: A retrospective cohort study was conducted using data from the Korean National Health Insurance Service claims database. The cohort included 201,678 CKD patients aged ≥40 years with a documented smoking history. Patients were stratified by smoking initiation age (<20 years vs. ≥20 years) and cumulative smoking exposure (pack-year, PY). The primary outcome was ESKD incidence, defined as kidney replacement therapy initiation. Cox proportional hazards models assessed the relationship between smoking initiation age, smoking burden, and ESKD risk.
RESULTS: During a median 6.8-year follow-up period, 6,334 patients progressed to ESKD (incidence rate, 3.63 per 1,000 PYs). Those with higher PYs were older and had more comorbidities, such as hypertension and diabetes mellitus. Patients who began smoking before age 20 years and accumulated ≥20 PYs had a significantly higher risk of ESKD (hazard ratio, 1.26; 95% confidence interval, 1.16-1.38) compared to those with the same exposure but later smoking initiation. Increased cumulative smoking exposure further elevated the risk. When PYs were divided according to initiation age, a higher ratio was associated with an increased risk of ESKD.
CONCLUSION: Early smoking initiation during adolescence was associated with a significantly higher risk of progression to ESKD in patients with CKD, especially in those with higher cumulative smoking exposure. Public health interventions focusing on preventing adolescent smoking can mitigate the long-term burden of CKD progression.
PMID:40985140 | DOI:10.23876/j.krcp.24.292
