title: The relationship between pulmonary emphysema and kidney function in smokers.
abstract: BACKGROUND
  It has been reported that the prevalence of kidney dysfunction may be increased in patients exposed to tobacco with airflow obstruction. We hypothesized that kidney dysfunction would associate with emphysema rather than with airflow obstruction measured by the FEV₁.
  
  
  METHODS
  Five hundred eight current and former smokers completed a chest CT scan, pulmonary function tests, medical questionnaires, and measurement of serum creatinine. Glomerular filtration rates (eGFRs) were estimated using the method of the Chronic Kidney Disease Epidemiology Collaboration. Quantitative determinants of emphysema and airway dimension were measured from multidetector chest CT scans.
  
  
  RESULTS
  The mean age was 66 ± 7 years, and mean eGFR was 101 ± 22 mL/min/1.73 m². Univariate and multivariate analysis showed a significant association between radiographically measured emphysema and eGFR: Participants with 10% more emphysema had an eGFR that was lower by 4.4 mL/min/1.73 m² (P = .01), independent of airflow obstruction (FEV₁), age, sex, race, height, BMI, diabetes mellitus, hypertension, coronary artery disease, patient-reported dyspnea, pack-years of smoking, and current smoking. There was no association between eGFR and either FEV₁ or quantitative CT scan measures of airway dimension.
  
  
  CONCLUSIONS
  More severe emphysema, rather than airflow obstruction, is associated with kidney dysfunction in tobacco smokers, independent of common risk factors for kidney disease. This finding adds to recent observations of associations between emphysema and comorbidities of COPD, including osteoporosis and lung cancer, which are independent of the traditional measure of reduced FEV₁. The mechanisms and clinical implications of kidney dysfunction in patients with emphysema need further investigation.
authors.affiliation: Emphysema COPD Research Center, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Divay
authors.initials: D
authors.lastname: Chandra
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Stamm
authors.affiliation: Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Palevsky
authors.affiliation: Department of Radiology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Leader
authors.affiliation: Department of Radiology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Carl R
authors.initials: CR
authors.lastname: Fuhrman
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Yingze
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Emphysema COPD Research Center, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Bon
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Duncan
authors.affiliation: Center for Clinical Pharmacology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Branch
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Joel
authors.initials: J
authors.lastname: Weissfeld
authors.affiliation: Department of Radiology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: David
authors.initials: D
authors.lastname: Gur
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA; Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Gladwin
authors.affiliation: Emphysema COPD Research Center, University of Pittsburgh, Pittsburgh, PA. Electronic address: sciurbafc@upmc.edu.
authors.forename: Frank C
authors.initials: FC
authors.lastname: Sciurba
mesh_terms: D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology; D011656:Pulmonary Emphysema / Q000503:physiopathology*; D012044:Regression Analysis; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects*
chemical_list: D003404:Creatinine