Smoking Timing, Healthy Diet, and Risk of Incident CKD Among Smokers: Findings From UK Biobank

Am J Kidney Dis. 2024 Jun 21:S0272-6386(24)00809-6. doi: 10.1053/j.ajkd.2024.04.011. Online ahead of print.


Rationale & objective: While smoking is a recognized risk factor for chronic kidney disease (CKD), the relationship between the time smoking is initiated after awakening each day and CKD remains largely unstudied. This study examined the association between this timing and the risk of CKD, and the potential interactions of smoking timing with other risk factors for the occurrence of CKD.

Study design: Observational cohort study.

Setting & participants: A total of 32,776 participants in the UK Biobank with complete data on the time from waking to the first cigarette and free of prevalent CKD were included.

Exposure: Time from waking to the first cigarette.

Outcome: Incident CKD cases.

Analytical approach: Cox proportional hazards regression was used to investigate the associations between the time smoking is initiated each day and the risk of CKD. The potential interactions of smoking timing with risk factors in relationship to CKD risk were assessed on both multiplicative and additive scales.

Results: During a median follow-up of 12 years, 940 incident CKD cases occurred. Shorter durations of time from waking to the first cigarette were associated with a higher risk of incident CKD (P-trend=0.01). Compared to >120 minutes, the adjusted hazard ratio (HR) associated with smoking timing was 1.28 (95% CI: 0.92-1.80) for 61-120 minutes, 1.48 (95% CI: 1.11-1.96) for 30-60 minutes, 1.36 (95% CI: 1.01-1.88) for 5-15 minutes, and 1.70 (95% CI: 1.22-2.37) for <5 minutes, respectively. Furthermore, there was a significant additive interaction and multiplicative interactions between the timing of smoking and a healthy diet score (P for additive interaction=0.01, P for multiplicative interaction=0.004).

Limitations: Generalizability; Possible residual confounding limiting causal inference.

Conclusion: These findings reveal a significant association between the shorter time from waking to the first cigarette and a higher CKD risk. The magnitude of these associations were greater in the setting of an unhealthy diet.

Keywords: CKD; Smoking timing; UK Biobank; additive interaction; diet; kidney failure.