kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2015.15.4.161 kjhp-15-161 Original Article Association between Respiratory Function and Albuminuria among Korean Male according to Smoking Status: The 2011 Korea National Health and Nutrition Examination Survey (KNHANES) JungHa Ji ChoiChang Jin ChoiHan na YounHyun Su YeoUi Hyang UenYoung Mi 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 122015 19122015 154 161167 30012015 14092015 Copyright © 2015 The Korean Society of Health Promotion and Disease Prevention 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. 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.

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Basic characteristics of the study subjectsa

Non smoker (n＝211) Smoker (n＝1,035) P‐valueb
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
HbA1C, % 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 exercisec 0.500
No 164 (79.6) 806 (76.8)
Yes 47 (20.4) 225 (23.1)

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

Calculated by t‐test or chi‐square test.

Regular 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.

Respiratory and kidney function of the study subjectsa

Non smoker (n＝211) Smoker (n＝1,035) P‐valueb
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
Albuminuriac 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 dysfunctiond ＜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.

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

Calculated by t‐test or chi‐square test.

Albuminuria: Urine Albumin Creatinine ratio ＞17 mg/g.

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

Linear correlation between respiratory function and kidney functiona

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‐valueb 0.067 0.020 ＜0.001 ＜0.001
eGFR, ml/min/1.73 m2 0.233 0.203 0.096 0.072
P‐valueb 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.

Data are presented as correlation coefficient r.

Calculated by Pearson correlation analysis.

Mean difference in FEV1, and FVC according to kidney functiona

Non‐smoker (n＝211) Smoker (n＝1,035)
FEV1, L FVC, L FEV1, L FVC, L
Model 1b Albuminuria, mg/gc
(‐) 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‐valued 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‐valued 0.355 0.679 0.774 0.098
Model2b Albuminuria, mg/gc
(‐) 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‐valued 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‐valued 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.

Data are presented as Mean±SE, unless otherwise indicated.

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

Albuminuira: Urine Albumin Creatinine ratio＞17 mg/g

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