Association between Respiratory Function and Albuminuria among Korean Male according to Smoking Status: The 2011 Korea National Health and Nutrition Examination Survey (KNHANES)

Ha Ji Jung; Chang Jin Choi; Han na Choi; Hyun Su Youn; Ui Hyang Yeo; Young Mi Uen

doi:10.15384/kjhp.2015.15.4.161

Korean J Health Promot > Volume 15(4); 2015 > Article

Jung, Choi, Choi, Youn, Yeo, and Uen: Association between Respiratory Function and Albuminuria among Korean Male according to Smoking Status: The 2011 Korea National Health and Nutrition Examination Survey (KNHANES)

Original Article

Korean Journal of Health Promotion 2015;15(4):161-167.

Published online: December 19, 2015

DOI: https://doi.org/10.15384/kjhp.2015.15.4.161

Association between Respiratory Function and Albuminuria among Korean Male according to Smoking Status: The 2011 Korea National Health and Nutrition Examination Survey (KNHANES)

Ha Ji Jung, Chang Jin Choi, Han na Choi, Hyun Su Youn, Ui Hyang Yeo, Young Mi Uen

Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

￭ Corresponding author：Chang Jin Choi, MD, PhD Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
Tel: +82-2-2258-2894, Fax: +82-2-2258-2907 E-mail: fmchcj@catholic.ac.kr

Received January 30, 2015 Accepted September 14, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background

Several studies have found an association between decreased respiratory function and renal impairment in those with chronic kidney disease. The relationship has not been investigated for healthy smokers. The aim of this study was to examine the association between respiratory function and renal function according to smoking status in Korean male population.

Methods

From the 5th Korean National Health and Nutrition Examination Survey (KNHANES), we enrolled 1246 male participants who were 40 years or older. As a cross‐sectional study, the association between respiratory function and renal function were analysed depending on the ’ smoking status. Pearson correlation analysis was used to find the association between respiratory function and renal impairment. Covariance Analysis allowed to compare renal function (albuminuria, eGFR) with respiratory function (FEV₁, FVC) according to smoking status.

Results

Regardless of smoking status, there was a negative correlation between respiratory function (FEV₁ and FVC) and urinary albumin to creatinine ratio (LogUACR), and positive correlation between respiratory function (FEV₁ and FVC) and estimated glomerular filtration rate (eGFR). Smokers have lower FEV₁ and FVC in case they have albuminuria, after adjusting for covariant (P＝0.012, P＝0.010, respectively).

Conclusions

Respiratory function was significantly lower in male smokers with albuminuria. Primary care physicians need to recognize that albuminuria may accompany with decreased respiratory function and to detect renal function impairment earlier in male smokers.

Keywords: Smoking, Respiratory function, Renal function, NHANES

Table 1.

Basic characteristics of the study subjects^a

	Non smoker (n＝211)	Smoker (n＝1,035)	P‐value^b
Age, years	54.9±0.9	54.8±0.5	0.891
Body mass index, kg/m²	24.3±0.2	24.4±0.1	0.664
Blood pressure, mmHg
Systolic	123.8±1.3	124.0±0.6	0.881
Diastolic	81.7±0.9	80.5±0.4	0.205
Glucose, mg/dL	100.6±1.8	102.8±0.9	0.292
HbA1_C, %	5.8±0.08	5.9±0.03	0.138
Diabetes mellitus	27 (8.1)	165 (15.0)	0.009
Hypertension	76 (33.3)	450 (42.3)	0.044
Cardiovascular disease	3 (0.68)	46 (3.50)	0.011
Drinking, g ethanol per day			0.005
0 g	50 (24.4)	151 (14.4)
≤ 30 g	136 (61.7)	675 (62.9)
＞30 g	25 (13.9)	209 (22.8)
Regular exercise^c			0.500
No	164 (79.6)	806 (76.8)
Yes	47 (20.4)	225 (23.1)

^aData are presented as Mean±SE, Number (%) unless otherwise indicated.

^bCalculated by t‐test or chi‐square test.

^cRegular exercise was indicated when the subject moderate exercise on a regular basis for more than 30 minutes at a time and more than five days per week, or severe exercise for more than 20 minutes at a time and more than three times per week.

Table 2.

Respiratory and kidney function of the study subjects^a

	Non smoker (n＝211)	Smoker (n＝1,035)	P‐value^b
FEV₁, L	3.23±0.06	3.14±0.03	0.172
FEV₁, predicted (%)	91.7±1.2	88.5±0.5	0.023
FVC, L	4.19±0.06	4.19±0.03	0.947
FVC, predicted (%)	91.8±1.0	91.6±0.5	0.853
FEV₁/FVC	0.77±0.007	0.75±0.003	＜0.001
Serum creatinine, mg/dL	0.98±0.010	0.97±0.006	0.208
eGFR, ml/min/1.73 m²	88.5±1.1	88.6±0.6	0.108
UACR, mg/g	23.6±11.0	26.6±9.5	0.844
Albuminuria^c			0.200
(‐)	198 (94.5)	942 (91.7)
(+)	13 (5.5)	93 (8.3)
eGFR, ml/min/1.73 m²			0.437
≥ 60	206 (98.0)	996 (97.1)
＜60	5 (2.0)	39 (2.9)
Ventilatory dysfunction^d			＜0.001
Normal	1,402 (78.3)	725 (65.8)
Restrictive pattern	151 (13.7)	135 (12.0)
Obstructive pattern	111 (8.0)	267 (22.2)

Abbreviations: FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; eGFR: estimated glomerular filtration rate; UACR, urine albumin creatinine ratio.

^aData are presented as Mean±SE, Number (%) unless otherwise indicated.

^bCalculated by t‐test or chi‐square test.

^cAlbuminuria: Urine Albumin Creatinine ratio ＞17 mg/g.

^dRestrictive pattern: FEV₁/FVC ≥ 0.7 and FEV₁＜80% (predicted), Obstructive pattern: FEV₁/FVC＜0.7.

Table 3.

Linear correlation between respiratory function and kidney function^a

	Non‐smoker (n＝211)		Smoker (n＝1,035)
	FEV₁, L	FVC, L	FEV₁, L	FVC, L
LogUACR, mg/g	‐0.156	‐0.180	‐0.132	‐0.136
P‐value^b	0.067	0.020	＜0.001	＜0.001
eGFR, ml/min/1.73 m²	0.233	0.203	0.096	0.072
P‐value^b	0.004	0.018	0.026	0.067

Abbreviations: FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; UACR, urine albumin creatinine ratio; eGFR, estimated glomerular filtration rate.

^aData are presented as correlation coefficient r.

^bCalculated by Pearson correlation analysis.

Table 4.

Mean difference in FEV₁, and FVC according to kidney function^a

	Non‐smoker (n＝211)		Smoker (n＝1,035)
	FEV₁, L	FVC, L	FEV₁, L	FVC, L
Model 1^b Albuminuria, mg/g^c
(‐)	3.14±0.04	4.12±0.05	3.07±0.02	4.15±0.03
(+)	3.05±0.20	3.82±0.20	2.91±0.06	3.96±0.07
P‐value^d	0.672	0.153	0.018	0.036
eGFR, ml/min/1.73 m²
≥ 60	3.14±0.04	4.10±0.04	3.06±0.02	3.99±0.09
＜60	3.29±0.16	4.19±0.22	3.04±0.07	4.14±0.03
P‐value^d	0.355	0.679	0.774	0.098
Model2^b Albuminuria, mg/g^c
(‐)	3.14±0.04	4.12±0.05	3.07±0.02	4.14±0.03
(+)	3.05±0.20	3.83±0.21	2.90±0.06	3.93±0.07
P‐value^d	0.654	0.186	0.012	0.010
eGFR, ml/min/1.73 m²
≥ 60	3.13±0.04	4.10±0.05	3.05±0.02	4.13±0.10
＜60	3.27±0.17	4.21±0.22	3.04±0.08	3.94±0.10
P‐value^d	0.469	0.594	0.874	0.075

Abbreviations: FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; eGFR, estimated glomerular filtration rate.

^aData are presented as Mean±SE, unless otherwise indicated.

^bModel 1 was adjusted for age and BMI; Model 2 as Model 1, with additional adjustment for hypertension, diabetes, exercises and drinking status.

^cAlbuminuira: Urine Albumin Creatinine ratio＞17 mg/g

^dCalculated by analysis of covariance comparing lung function with renal function according to smoking status.

REFERENCES

1.. Edwards R. The problem of tobacco smoking. BMJ 2004;328(7433):217-9.

2.. Korea health statistics 2010. The 5th Korea National Health and Nutrition Examination Survey (KNHANESV–1). Cheongju: Korea Centers for Disease Control and Prevention; 2010. [Accessed July 15, 2013].. https://knhanes.cdc.go.kr/knhanes/index.do.

3.. Song HR, Kim CH. Epidemiology of the smoking–related diseases in Korea. J Korean Acad Fam Med 2008;29(8):563-71.

4.. Gambaro G, Verlato F, Budakovic A, Casara D, Saladini G, Del Prete D, et al. Renal impairment in chronic cigarette smokers. J Am Soc Nephrol 1998;9(4):562-7.

5.. Noborisaka Y. Smoking and chronic kidney disease in healthy populations. Nephrourol Mon 2013;5(1):655-67.

6.. Locatelli F, Vecchio LD, Pozzoni P. The importance of early detection of chronic kidney disease. Nephrol Dial Transplant 2002;17(Suppl 11):2-7.

7.. Stevens PE, Levin A. Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 2013;158(11):825-30.

8.. Jafar TH, Chaturvedi N, Hatcher J, Levey AS. Use of albumin creatinine ratio and urine albumin concentration as a screening test for albuminuria in an Indo–Asian population. Nephrol Dial Transplant 2007;22(8):2194-200.

9.. Tkácová R, Tkác I, Podracký J, Moscovic P, Roland R, Hildebrand T. Spirometric alterations in patients with reduced renal function. Wien Klin Wochenschr 1993;105(1):21-4.

10.. Yoon JH, Won JU, Ahn YS, Roh J. Poor lung function has inverse relationship with microalbuminuria, an early surrogate marker of kidney damage and atherosclerosis: the 5th Korea National Health and Nutrition Examination Survey. PLoS One 2014;9(4):e94125.

11.. Casanova C, de Torres JP, Navarro J, Aguirre–Jaíme A, Toledo P, Cordoba E, et al. Microalbuminuria and hypoxemia in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2010;182(8):): 1004–10.

12.. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J 2005;26(2):319-38.

13.. Choi JK, Paek D, Lee JO. Normal predictive values of Spirometry in Korean population. Tuberc Respir Dis 2005;58(3):230-42.

14.. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 1999;130(6):461-70.

15.. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39(2 Suppl 1):): S1–266..

16.. Anand S, Khanam MA, Saquib J, Saquib N, Ahmed T, Alam DS, et al. High prevalence of chronic kidney disease in a community survey of urban Bangladeshis: a cross–sectional study. Global Health 2014;10:9.

17.. Pinto–Sietsma SJ, Mulder J, Janssen WM, Hillege HL, de Zeeuw D, de Jong PE. Smoking is related to albuminuria and abnormal renal function in nondiabetic persons. Ann Intern Med 2000;133:585-91.

18.. Maeda I, Hayashi T, Sato KK, Koh H, Harita N, Nakamura Y, et al. Cigarette smoking and the association with glomerular hy-perfiltration and proteinuria in healthy middle–aged men. Clin J Am Soc Nephrol 2011;6(10):2462-9.

19.. Shankar A, Klein R, Klein BE. The association among smoking, heavy drinking, and chronic kidney disease. Am J Epidemiol 2006;164(3):263-71.

20.. Yamagata K, Ishida K, Sairenchi T, Takahashi H, Ohba S, Shiigai T, et al. Risk factors for chronic kidney disease in a com-munity–based population: a 10–year follow–up study. Kidney Int 2007;71(2):159-66.

21.. Briganti EM, Branley P, Chadban SJ, Shaw JE, McNeil JJ, Welborn TA, et al. Smoking is associated with renal impairment and proteinuria in the normal population: the AusDiab kidney study. Am J Kidney Dis 2002;40(4):704-12.

22.. Halimi JM, Giraudeau B, Vol S, Cacès E, Nivet H, Lebranchu Y, et al. Effects of current smoking and smoking discontinuation on renal function and proteinuria in the general population. Kidney Int 2000;58(3):1285-92.

23.. Noborisaka Y, Honda R, Ishizaki M, Nakata M, Yamada Y. Alcohol and cigarette consumption, renal function and blood pressure in middle–aged healthy men. J Hum Hypertens 2007;21(12):966-8.

24.. Yoon HJ, Park M, Yoon H, Son KY, Cho B, Kim S. The differential effect of cigarette smoking on glomerular filtration rate and proteinuria in an apparently healthy population. Hypertens Res 2009;32(3):214-9.

25.. Zhang L, Zhang P, Wang F, Zuo L, Zhou Y, Shi Y, et al. Prevalence and factors associated with CKD: a population study from Beijing. Am J Kidney Dis 2008;51(3):373-84.

26.. Bazzano LA, He J, Muntner P, Vupputuri S, Whelton PK. Relationship between cigarette smoking and novel risk factors for cardiovascular disease in the United States. Ann Intern Med 2003;138(11):891-7.

27.. Gan WQ, Man SF, Sin DD. The interactions between cigarette smoking and reduced lung function on systemic inflammation. Chest 2005;127(2):558-64.

28.. Eagan TM, Ueland T, Wagner PD, Hardie JA, Mollnes TE, Damås JK, et al. Systemic inflammatory markers in COPD: results from the Bergen COPD Cohort Study. Eur Respir J 2010;35(5):540-8.

29.. Arici M, Walls J. End–stage renal disease, atherosclerosis, and cardiovascular mortality: is C–reactive protein the missing link? Kidney Int 2001;59(2):407-14.

30.. Yanbaeva DG, Dentener MA, Creutzberg EC, Wesseling G, Wouters EF. Systemic effects of smoking. Chest 2007;131(5):1557-66.