Smokeless tobacco consumption and its association with risk factors of chronic kidney disease in rural and peri-urban Bangladesh

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Abstract

INTRODUCTION

Compared to smoking, which has major consequences in chronic kidney disease (CKD) initiation and progression, smokeless tobacco (SLT) consumption is considered to have fewer health consequences. We investigated the prevalence of SLT consumption and its association with risk factors of CKD in a rural and peri-urban Bangladeshi population.

METHODS

Using random sampling we recruited 872 adults in 2020, from the Mirzapur Demographic Surveillance System of Bangladesh, who had resided in the area for at least five years. Interviews using a semi-structured questionnaire, physical examination and anthropometric measurements were done, followed by blood and urine testing. The blood and urine tests were repeated in selected participants after three months as per the CKD Epidemiology Collaboration equation.

RESULTS

The prevalence of SLT consumption was 29%. Being aged ≥46 years (OR=7.10; 95% CI: 4.79-10.94), female (OR=1.64; 95% CI: 1.21–2.22), housewife (OR=1.82; 95% CI: 1.35–2.45), farmer (OR=1.71; 95% CI: 1.06–2.76), widow (OR=3.40; 95% CI: 2.24–5.17), and having no formal schooling (OR=4.91; 95% CI: 3.59–6.72), family income of <$100/month (OR=1.66; 95% CI: 1.13–2.43), sleeping duration <7 hours per day (OR=2.33; 95% CI: 1.70–3.19), were associated with a significantly higher odds of SLT consumption. However, being aged 31–45 years (OR=0.25; 95% CI: 0.16–0.38) had significantly lower odds of being an SLT consumer. Among the diseases investigated, undernutrition (OR=1.63; 95% CI: 1.15–2.33), hypertension (OR=1.52; 95% CI: 1.13–2.05), anemia (OR=1.94; 95% CI: 1.39–2.71) and CKD (OR=1.62; 95% CI: 1.15–2.27) were significantly associated with SLT consumption. In the multivariable analysis, being aged 31–45 years (AOR=3.06; 95% CI: 1.91–4.90), ≥46 years (AOR=15.69; 95% CI: 4.64–53.09) and having no formal schooling (AOR=2.47; 95% CI: 1.72–3.55) were found to have a significant association with being an SLT consumer.

CONCLUSIONS

SLT consumption is associated with most of the established risk factors of CKD within the studied population.

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Most cited references 36

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Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Boris Bikbov, Caroline A. Purcell, Andrew Levey … (2021)

Summary Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI. Funding Bill & Melinda Gates Foundation.

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Chronic Kidney Disease.

Angela Webster, Evi V Nagler, Rachael Morton … (2017)

The definition and classification of chronic kidney disease (CKD) have evolved over time, but current international guidelines define this condition as decreased kidney function shown by glomerular filtration rate (GFR) of less than 60 mL/min per 1·73 m(2), or markers of kidney damage, or both, of at least 3 months duration, regardless of the underlying cause. Diabetes and hypertension are the main causes of CKD in all high-income and middle-income countries, and also in many low-income countries. Incidence, prevalence, and progression of CKD also vary within countries by ethnicity and social determinants of health, possibly through epigenetic influence. Many people are asymptomatic or have non-specific symptoms such as lethargy, itch, or loss of appetite. Diagnosis is commonly made after chance findings from screening tests (urinary dipstick or blood tests), or when symptoms become severe. The best available indicator of overall kidney function is GFR, which is measured either via exogenous markers (eg, DTPA, iohexol), or estimated using equations. Presence of proteinuria is associated with increased risk of progression of CKD and death. Kidney biopsy samples can show definitive evidence of CKD, through common changes such as glomerular sclerosis, tubular atrophy, and interstitial fibrosis. Complications include anaemia due to reduced production of erythropoietin by the kidney; reduced red blood cell survival and iron deficiency; and mineral bone disease caused by disturbed vitamin D, calcium, and phosphate metabolism. People with CKD are five to ten times more likely to die prematurely than they are to progress to end stage kidney disease. This increased risk of death rises exponentially as kidney function worsens and is largely attributable to death from cardiovascular disease, although cancer incidence and mortality are also increased. Health-related quality of life is substantially lower for people with CKD than for the general population, and falls as GFR declines. Interventions targeting specific symptoms, or aimed at supporting educational or lifestyle considerations, make a positive difference to people living with CKD. Inequity in access to services for this disease disproportionally affects disadvantaged populations, and health service provision to incentivise early intervention over provision of care only for advanced CKD is still evolving in many countries.

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Worldwide access to treatment for end-stage kidney disease: a systematic review.

Thaminda Liyanage, Toshiharu Ninomiya, Vivekanand Jha … (2015)

End-stage kidney disease is a leading cause of morbidity and mortality worldwide. Prevalence of the disease and worldwide use of renal replacement therapy (RRT) are expected to rise sharply in the next decade. We aimed to quantify estimates of this burden.

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Author and article information

Journal

Journal ID (nlm-ta): Tob Induc Dis

Journal ID (iso-abbrev): Tob Induc Dis

Journal ID (publisher-id): TID

Title: Tobacco Induced Diseases

Publisher: European Publishing on behalf of the International Society for the Prevention of Tobacco Induced Diseases (ISPTID)

ISSN (Print): 2070-7266

ISSN (Electronic): 1617-9625

Publication date (Electronic): 20 October 2023

Publication date Collection: 2023

Volume: 21

Electronic Location Identifier: 138

Affiliations

[1 ]Technical Training Unit, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh

[2 ]Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

[3 ]Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh

[4 ]Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh

Author notes

CORRESPONDENCE TO Mohammad H.R. Sarker. Technical Training Unit, International Centre for Diarrheal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmad Sarani, 1212 Dhaka, Bangladesh. E-mail: habibur.rahman@ 123456icddrb.org ORCID ID: https://orcid.org/0000-0001-9614-0806

Article

Publisher ID: 138

DOI: 10.18332/tid/171358

PMC ID: 10588374

PubMed ID: 37869615

SO-VID: 7edf956e-2e5f-4d70-9cbd-97621811cdd1

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License.

History

Date received : 24 April 2023

Date revision received : 07 August 2023

Date accepted : 17 August 2023

Smokeless tobacco consumption and its association with risk factors of chronic kidney disease in rural and peri-urban Bangladesh

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Abstract

INTRODUCTION

METHODS

RESULTS

CONCLUSIONS

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Tobacco Prevention & Cessation

Most cited references 36

Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Chronic Kidney Disease.

Worldwide access to treatment for end-stage kidney disease: a systematic review.

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