Study reveals association between smokeless tobacco and chronic kidney disease

A comprehensive study, conducted by Dr. Mohammad Habibur Rahman Sarker et al. in 2020 with 872 adults from the Mirzapur Demographic Surveillance System in Bangladesh, has revealed that smokeless tobacco (SLT) comprised of Zarda, Sadapata, and Gul consumption is significantly associated with an increased risk of Chronic Kidney Disease (CKD). This groundbreaking research sheds light on a critical health concern often overshadowed by broader tobacco discussions.

The study was performed on adults who had resided in the area for at least five years. Interviews, physical examinations, anthropometric measurements, as well as blood and urine testing, were conducted. The blood and urine tests were repeated in probable CKD  participants after three months to confirm CKD as per the CKD Epidemiology Collaboration equation.

The research highlighted age as a significant factor: ~43% of adults aged 46 or above reported SLT consumption, while only about 10% of adults between 18 and 45 mentioned SLT consumption. Certain demographics — including housewives, farmers, widows, and those without formal education — emerged as being more prone to SLT consumption. For instance, 50% among those with no formal education reported SLT use, which is substantially higher than the adult population-level prevalence of 29%.

Lower income and having fewer hours of sleep were also identified as noteworthy factors for SLT use. Individuals with a monthly income below BDT 10,000 and those sleeping fewer than 7 hours daily were more inclined to use SLT.  Finally, the study identified several health conditions — including undernutrition, hypertension, anaemia, and chronic kidney disease (CKD) — associated with SLT use.

In this regard, Dr. Sarker said “The risk of developing CKD is 1.62 times higher for SLT users than for non-users.  Smokeless tobacco is often considered a safer alternative to smoking cigarettes, but our findings show that they carry many of the same risks. It remains extremely common in Bangladesh to chew dried tobacco leaves along with betel nut. Anti-tobacco public health campaigns must incorporate such traditional forms of smokeless tobacco consumption, as well as newer forms like e-cigarettes, which contain nicotine derived from tobacco.”

The study emphasizes the critical role of education and awareness in combatting the prevalence of SLT consumption, particularly among those with vulnerable demographics such as women, individuals with limited education, and those in lower socio-economic contexts.

The study's findings carry significant global implications, especially in countries where SLT consumption is deeply rooted in cultural practices. SLT is a cultural practice in Bangladesh and is viewed as a Westerners’ drinking coffee every day. Eighty percent of global consumption occurs in South-East Asia with Bangladesh being the second-largest consumer, after India.     

The research calls for urgent attention to this overlooked facet of tobacco control, advocating for a comprehensive approach that includes SLT in existing tobacco control strategies. Efforts to mitigate the risks associated with CKD in developing nations must incorporate measures to control SLT consumption.