TY - JOUR
T1 - Self-reported tobacco, alcohol, and illicit drug use and progression of chronic kidney disease
AU - CRIC Study Investigators
AU - Bundy, Joshua D.
AU - Bazzano, Lydia A.
AU - Xie, Dawei
AU - Cohan, Janet
AU - Dolata, Jacqueline
AU - Fink, Jeffrey C.
AU - Hsu, Chi Yuan
AU - Jamerson, Kenneth
AU - Lash, James
AU - Makos, Gail
AU - Steigerwalt, Susan
AU - Wang, Xue
AU - Mills, Katherine T.
AU - Chen, Jing
AU - He, Jiang
AU - Appel, Lawrence J.
AU - Feldman, Harold I.
AU - Go, Alan S.
AU - Kusek, John W.
AU - Ojo, Akinlolu
AU - Rahman, Mahboob
AU - Townsend, Raymond R.
N1 - Funding Information:
Funding for the CRIC Study was obtained under a cooperative agreement from the National Institute of Diabetes and Digestive and Kidney Diseases (grants U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, and U01DK060902). In addition, this study was supported, in part, by Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award National Institutes of Health/National Center for Advancing Translational Sciences grant UL1TR000003, Johns Hopkins Institute for Clinical and Translational Research grant UL1 TR-000424, University of Maryland General Clinical Research Center grant M01 RR-16500, Clinical and Translational Science Collaborative of Cleveland grant UL1TR000439, Michigan Institute for Clinical and Health Research grant UL1TR000433, University of Illinois at Chicago Clinical and TranslationalScience Awards grantUL1RR029879,TulaneCenterof Biomedical Research Excellence for Clinical and Translational Re-searchinCardiometabolicDiseasesgrantP20GM109036,andKaiser Permanente NIH/National Center for Research Resources Uni-versityof California SanFranciscoClinicalandTranslationalScience Institute grant UL1 RR-024131.
Funding Information:
The authors thank the participants, investigators, and staff of the Chronic Renal Insufficiency Cohort (CRIC) Study for their time and commitment. Funding for the CRIC Study was obtained under a cooperative agreement from the National Institute of Diabetes and Digestive and Kidney Diseases (grants U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, and U01DK060902). In addition, this study was supported, in part, by Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award National Institutes of Health/National Center for Advancing Translational Sciences grant UL1TR000003, Johns Hopkins Institute for Clinical and Translational Research grant UL1 TR-000424, University of Maryland General Clinical Research Center grant M01 RR-16500, Clinical and Translational Science Collaborative of Cleveland grant UL1TR000439, Michigan Institute for Clinical and Health Research grant UL1TR000433, University of Illinois at Chicago Clinical and Translational Science Awards grant UL1RR029879, Tulane Center of Biomedical Research Excellence for Clinical and Translational Research in Cardiometabolic Diseases grant P20 GM109036, and Kaiser Permanente NIH/National Center for Research Resources University of California San Francisco Clinical and Translational Science Institute grant UL1 RR-024131.
Publisher Copyright:
© 2018 by the American Society of Nephrology.
PY - 2018/7/6
Y1 - 2018/7/6
N2 - Background and objectives Previous studies suggest that tobacco, alcohol, and illicit drug use is associated with CKD. We examined the associations of substance use with CKD progression and all-cause mortality among patients with CKD. Design, setting, participants, & measurements The Chronic Renal Insufficiency Cohort Study is a prospective, longitudinal cohort study among 3939 participants with CKD in the United States. Self-reported tobacco smoking, alcohol drinking, marijuana use, and hard illicit drug (cocaine, heroin, or methamphetamine) use were obtained at baseline and annual follow-up visits. CKD progression was defined as incident ESKD or halving of eGFR. Substance use was modeled as the cumulative average exposure to capture both recent and long-term use in multivariable time-dependent Cox regression. Results Over a median 5.5-year follow-up, 1287 participants developed CKD progression, and 1001 died. Baseline proportions of tobacco smoking, alcohol drinking, marijuana use, and hard illicit drug use were 13%, 20%, 33%, and 12%, respectively. Compared with nonsmoking throughout follow-up, multivariable-adjusted hazard ratios for persistent tobacco smoking were 1.02 (95% confidence interval, 0.86 to 1.21) for CKD progression and 1.86 (95% confidence interval, 1.54 to 2.24) for all-cause mortality. Compared with nondrinking throughout follow-up, multivariable-adjusted hazard ratios for persistent alcohol drinking were 1.06 (95% confidence interval, 0.88 to 1.29) for CKD progression and 0.73 (95% confidence interval, 0.58 to 0.91) for all-cause mortality. Compared with nonuse throughout follow-up, multivariable-adjusted hazard ratios for persistent marijuana use were 0.94 (95% confidence interval, 0.82 to 1.07) for CKD progression and 1.11 (95% confidence interval, 0.96 to 1.30) for all-cause mortality. Compared with nonuse throughout follow-up, multivariable-adjusted hazard ratios for persistent hard illicit drug use were 1.25 (95% confidence interval, 1.00 to 1.55) for CKD progression and 1.41 (95% confidence interval, 1.10 to 1.81) for all-cause mortality. Conclusions Hard illicit drug use is associated with higher risk of CKD progression andall-cause mortality, tobacco smoking is associated with higher risk of all-cause mortality, and alcohol drinking is associated with lower risk of all-cause mortality among patients with CKD.
AB - Background and objectives Previous studies suggest that tobacco, alcohol, and illicit drug use is associated with CKD. We examined the associations of substance use with CKD progression and all-cause mortality among patients with CKD. Design, setting, participants, & measurements The Chronic Renal Insufficiency Cohort Study is a prospective, longitudinal cohort study among 3939 participants with CKD in the United States. Self-reported tobacco smoking, alcohol drinking, marijuana use, and hard illicit drug (cocaine, heroin, or methamphetamine) use were obtained at baseline and annual follow-up visits. CKD progression was defined as incident ESKD or halving of eGFR. Substance use was modeled as the cumulative average exposure to capture both recent and long-term use in multivariable time-dependent Cox regression. Results Over a median 5.5-year follow-up, 1287 participants developed CKD progression, and 1001 died. Baseline proportions of tobacco smoking, alcohol drinking, marijuana use, and hard illicit drug use were 13%, 20%, 33%, and 12%, respectively. Compared with nonsmoking throughout follow-up, multivariable-adjusted hazard ratios for persistent tobacco smoking were 1.02 (95% confidence interval, 0.86 to 1.21) for CKD progression and 1.86 (95% confidence interval, 1.54 to 2.24) for all-cause mortality. Compared with nondrinking throughout follow-up, multivariable-adjusted hazard ratios for persistent alcohol drinking were 1.06 (95% confidence interval, 0.88 to 1.29) for CKD progression and 0.73 (95% confidence interval, 0.58 to 0.91) for all-cause mortality. Compared with nonuse throughout follow-up, multivariable-adjusted hazard ratios for persistent marijuana use were 0.94 (95% confidence interval, 0.82 to 1.07) for CKD progression and 1.11 (95% confidence interval, 0.96 to 1.30) for all-cause mortality. Compared with nonuse throughout follow-up, multivariable-adjusted hazard ratios for persistent hard illicit drug use were 1.25 (95% confidence interval, 1.00 to 1.55) for CKD progression and 1.41 (95% confidence interval, 1.10 to 1.81) for all-cause mortality. Conclusions Hard illicit drug use is associated with higher risk of CKD progression andall-cause mortality, tobacco smoking is associated with higher risk of all-cause mortality, and alcohol drinking is associated with lower risk of all-cause mortality among patients with CKD.
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U2 - 10.2215/CJN.11121017
DO - 10.2215/CJN.11121017
M3 - Article
C2 - 29880471
AN - SCOPUS:85049801506
SN - 1555-9041
VL - 13
SP - 993
EP - 1001
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 7
ER -