Secondhand smoke exposure is associated with proteinuria in children with chronic kidney disease

Abiodun Omoloja, Judith Jerry-Fluker, Derek K. Ng, Alison G. Abraham, Susan Furth, Bradley A. Warady, Mark Mitsnefes

Research output: Contribution to journalArticlepeer-review


Background: In adults with chronic kidney disease (CKD), cigarette smoking is associated with an increased risk for CKD progression and transplant failure. In children, secondhand smoke (SHS) exposure has been associated with elevated blood pressure. There are no studies on the prevalence and effect of SHS exposure in CKD. Methods: Subjects were enrolled in the Chronic Kidney Disease in Children (CKiD) Study, an observational cohort of 366 children aged 1 to 16 years with CKD. Secondhand smoke exposure was obtained via questionnaire. SHS exposure was also determined based on urine cotinine (Ucot) measurements (1 ng/mL ≤ Ucot < 75 ng/mL). The cross-sectional association of SHS exposure with proteinuria was assessed. Results: Using Ucot, 22 % of subjects were exposed to SHS. SHS exposure was significantly associated with lower maternal education and African American race, and a greater prevalence of nephrotic range proteinuria and left ventricular hypertrophy. In a multivariate model (including sex, age, race, maternal education, income level, private insurance status, abnormal birth history and CKD diagnosis), the prevalence odds of nephrotic range proteinuria was 2.64, (95 % confidence interval 1.08, 6.42) higher in children exposed to SHS compared to those unexposed. Conclusions: In our cohort of children with CKD, SHS exposure was common (22 %) and independently associated with nephrotic range proteinuria. Exposure to SHS may be an important factor to consider in CKD progression.

Original languageEnglish (US)
Pages (from-to)1243-1251
Number of pages9
JournalPediatric Nephrology
Issue number8
StatePublished - Aug 2013


  • Chronic kidney disease progression
  • Pediatric chronic kidney disease
  • Proteinuria
  • Secondhand smoke exposure
  • Tobacco use
  • Urine cotinine

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology


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