Ignoring the obvious missing piece of chronic kidney disease in HIV: cigarette smoking.

The impact of tobacco use on the development of chronic kidney disease (CKD) in people living with HIV (PLWH) has been overlooked, despite remarkably higher rates of smoking in these individuals. The authors examined the association between smoking and the risk of CKD in a case-controlled study that included 75 PLWH with CKD and 461 PLWH consecutively admitted to the hospital for other causes. Significant differences in gender, race/ethnicity, hypertension, hepatitis B, CD4 cell counts, and smoking between cases and controls were reported, suggesting that these variables may be risk factors for CKD. In logistic regression analyses, smoking (OR=1.97, p=.003), hypertension (OR=2), and African ancestry, particularly for Black Caribbeans (OR=2.6), were independent factors associated with CKD. Moreover, the results pointed to a dose-response relationship between packs smoked per day and CKD. Smoking was reported to contribute a significant risk for CKD in these subjects.