title: Smoking and risk of kidney failure in the Singapore Chinese health study.
abstract: BACKGROUND
  The relationship between smoking and risk of kidney failure, especially in people of Chinese origin, is not clear. We analyzed data from the Singapore Chinese Health Study to investigate whether smoking increases the risk of kidney failure.
  
  
  METHODS
  The Singapore Chinese Health Study is a population-based cohort of 63,257 Chinese adults enrolled between 1993 and 1998. Information on smoking status was collected at baseline. Incidence of kidney failure was identified via record linkage with the nationwide Singapore Renal Registry until 2008. Kidney failure was defined by one of the following: 1) serum creatinine level of more than or equal to 500 µmol/l (5.7 mg/dl), 2) estimated glomerular filtration rate of less than 15 ml/min/1.73 m(2), 3) undergoing hemodialysis or peritoneal dialysis, 4) undergone kidney transplantation. Cox proportional hazard regression analysis was performed for the outcome of kidney failure after adjusting for age, education, dialect, herbal medications, body mass index, sex, physician-diagnosed hypertension and diabetes mellitus.
  
  
  RESULTS
  The mean age of subjects was 55.6 years at baseline, and 44% were men. Overall 30.6% were ever smokers (current or former) at baseline. A total of 674 incident cases of kidney failure occurred during a median follow-up of 13.3 years. Among men, smokers had a significant increase in the adjusted risk of kidney failure [hazard ratio (HR): 1.29; 95% CI: 1.02-1.64] compared to never smokers. There was a strong dose-dependent association between number of years of smoking and kidney failure, (p for trend = 0.011). The risk decreased with prolonged cessation (quitting ≥10 years since baseline). The number of women smokers was too few for conclusive relationship.
  
  
  CONCLUSIONS
  Information on baseline kidney function was not available.
  
  
  CONCLUSIONS
  Cigarette smoking is associated with increased risk of kidney failure among Chinese men. The risk appears to be dose- and duration-dependent and modifiable after long duration of cessation.
authors.affiliation: National Registry of Diseases Office, Health Promotion Board, Singapore, Singapore.
authors.forename: Aizhen
authors.initials: A
authors.lastname: Jin
authors.forename: Woon-Puay
authors.initials: WP
authors.lastname: Koh
authors.forename: Khuan Yew
authors.initials: KY
authors.lastname: Chow
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Yuan
authors.forename: Tazeen Hasan
authors.initials: TH
authors.lastname: Jafar
mesh_terms: D000368:Aged; D044466:Asian People; D002681:China / Q000208:ethnology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D051437:Renal Insufficiency / Q000175:diagnosis / Q000208:ethnology* / Q000209:etiology*; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D012907:Smoking / Q000009:adverse effects*