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Original Research |

The Relationship Between Pulmonary Emphysema and Kidney Function in SmokersEmphysema and Kidney Function

Divay Chandra, MD; Jason A. Stamm, MD; Paul M. Palevsky, MD, FCCP; Joseph K. Leader, PhD; Carl R. Fuhrman, MD, FCCP; Yingze Zhang, PhD; Jessica Bon, MD; Steven R. Duncan, MD; Robert A. Branch, MD; Joel Weissfeld, MD, MPH; David Gur, ScD; Mark T. Gladwin, MD; Frank C. Sciurba, MD, FCCP
Author and Funding Information

From the Emphysema COPD Research Center (Drs Chandra, Bon, and Sciurba), Division of Pulmonary, Allergy, and Critical Care Medicine (Drs Stamm, Zhang, Duncan, and Gladwin), the Renal-Electrolyte Division (Dr Palevsky), the Department of Radiology (Drs Leader, Fuhrman, and Gur), the Center for Clinical Pharmacology (Dr Branch), the Department of Epidemiology, Graduate School of Public Health (Dr Weissfeld), and the Vascular Medicine Institute (Dr Gladwin), University of Pittsburgh, Pittsburgh, PA.

Correspondence to: Frank C. Sciurba, MD, FCCP, Kaufmann Bldg, Ste 1211, 3471 Fifth Ave, Pittsburgh, PA 15213; e-mail: sciurbafc@upmc.edu


Drs Chandra and Stamm contributed equally to this article.

Funding/Support: This work is supported in part by the National Institutes of Health through the University of Pittsburgh [Grants 1P50 HL084948 (SCCOR in COPD), P50-CA90440, R01 HL085096, and UL1 RR024153]. Roche Diagnostics (Manheim, Germany) funded an investigator-initiated grant (to Dr Zhang) in the form of N-terminal pro-brain natriuretic peptide assays and financial support for personnel associated with the N-terminal pro-brain natriuretic peptide analysis of this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(3):655-662. doi:10.1378/chest.11-1456
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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.

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