TY - JOUR
T1 - Smoking and Adverse Outcomes in Patients With CKD
T2 - The Study of Heart and Renal Protection (SHARP)
AU - Staplin, Natalie
AU - Haynes, Richard
AU - Herrington, William G
AU - Reith, Christina
AU - Cass, Alan
AU - Fellström, Bengt
AU - Jiang, Lixin
AU - Kasiske, Bertram L
AU - Krane, Vera
AU - Levin, Adeera
AU - Walker, Robert
AU - Wanner, Christoph
AU - Wheeler, David C
AU - Landray, Martin J
AU - Baigent, Colin
AU - Emberson, Jonathan
AU - SHARP Collaborative Group (Bo Feldt-Rasmussen, member)
A2 - Feldt-Rasmussen, Bo Friis
N1 - Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.
PY - 2016/9
Y1 - 2016/9
N2 - BACKGROUND: The absolute and relative importance of smoking to vascular and nonvascular outcomes in people with chronic kidney disease (CKD), as well its relevance to kidney disease progression, is uncertain.STUDY DESIGN: Observational study.SETTING & PARTICIPANTS: 9,270 participants with CKD enrolled in SHARP.PREDICTOR: Baseline smoking status (current, former, and never).OUTCOMES: Vascular events, site-specific cancer, ESRD, rate of change in estimated glomerular filtration rate (eGFR), and cause-specific mortality.RESULTS: At baseline, 1,243 (13%) participants were current smokers (median consumption, 10 cigarettes/day); 3,272 (35%), former smokers; and 4,755 (51%), never smokers. Median follow-up was 4.9 years. Vascular event rates were 36% higher for current than never smokers (2,317 events; relative risk [RR], 1.36; 95% CI, 1.19-1.55), reflecting increases in both atherosclerotic (RR, 1.49; 95% CI, 1.26-1.76) and nonatherosclerotic (RR, 1.25; 95% CI, 1.05-1.50) events. Cancer was 37% higher among current smokers (632 events; RR, 1.37; 95% CI, 1.07-1.76), with the biggest RRs for lung (RR, 9.31; 95% CI, 4.37-19.83) and upper aerodigestive tract (RR, 4.87; 95% CI, 2.10-11.32) cancers. For 6,245 patients not receiving dialysis at baseline, ESRD incidence did not differ significantly between current and never smokers (2,141 events; RR, 1.02; 95% CI, 0.89-1.17), nor did estimated rate of change in eGFR (current smokers, -1.77±0.14 [SE]; never smokers, -1.70±0.07mL/min/1.73m(2) per year). All-cause mortality was 48% higher among current smokers (2,257 events; RR, 1.48; 95% CI, 1.30-1.70), with significant increases in vascular (RR, 1.35; 95% CI, 1.07-1.69) and nonvascular (RR, 1.60; 95% CI, 1.34-1.91) causes of death, especially cancer (RR, 2.32; 95% CI, 1.58-3.40) and respiratory (RR, 2.25; 95% CI, 1.51-3.35) mortality.LIMITATIONS: Smoking status not assessed during follow-up.CONCLUSIONS: In this study of patients with CKD, smoking significantly increased the risks for vascular and nonvascular morbidity and mortality, but was not associated with kidney disease progression. The associations with vascular and neoplastic disease are in keeping with those observed in the general population and are likely modifiable by cessation.
AB - BACKGROUND: The absolute and relative importance of smoking to vascular and nonvascular outcomes in people with chronic kidney disease (CKD), as well its relevance to kidney disease progression, is uncertain.STUDY DESIGN: Observational study.SETTING & PARTICIPANTS: 9,270 participants with CKD enrolled in SHARP.PREDICTOR: Baseline smoking status (current, former, and never).OUTCOMES: Vascular events, site-specific cancer, ESRD, rate of change in estimated glomerular filtration rate (eGFR), and cause-specific mortality.RESULTS: At baseline, 1,243 (13%) participants were current smokers (median consumption, 10 cigarettes/day); 3,272 (35%), former smokers; and 4,755 (51%), never smokers. Median follow-up was 4.9 years. Vascular event rates were 36% higher for current than never smokers (2,317 events; relative risk [RR], 1.36; 95% CI, 1.19-1.55), reflecting increases in both atherosclerotic (RR, 1.49; 95% CI, 1.26-1.76) and nonatherosclerotic (RR, 1.25; 95% CI, 1.05-1.50) events. Cancer was 37% higher among current smokers (632 events; RR, 1.37; 95% CI, 1.07-1.76), with the biggest RRs for lung (RR, 9.31; 95% CI, 4.37-19.83) and upper aerodigestive tract (RR, 4.87; 95% CI, 2.10-11.32) cancers. For 6,245 patients not receiving dialysis at baseline, ESRD incidence did not differ significantly between current and never smokers (2,141 events; RR, 1.02; 95% CI, 0.89-1.17), nor did estimated rate of change in eGFR (current smokers, -1.77±0.14 [SE]; never smokers, -1.70±0.07mL/min/1.73m(2) per year). All-cause mortality was 48% higher among current smokers (2,257 events; RR, 1.48; 95% CI, 1.30-1.70), with significant increases in vascular (RR, 1.35; 95% CI, 1.07-1.69) and nonvascular (RR, 1.60; 95% CI, 1.34-1.91) causes of death, especially cancer (RR, 2.32; 95% CI, 1.58-3.40) and respiratory (RR, 2.25; 95% CI, 1.51-3.35) mortality.LIMITATIONS: Smoking status not assessed during follow-up.CONCLUSIONS: In this study of patients with CKD, smoking significantly increased the risks for vascular and nonvascular morbidity and mortality, but was not associated with kidney disease progression. The associations with vascular and neoplastic disease are in keeping with those observed in the general population and are likely modifiable by cessation.
KW - Cardiovascular Diseases
KW - Disease Progression
KW - Female
KW - Heart Diseases
KW - Humans
KW - Kidney Failure, Chronic
KW - Male
KW - Middle Aged
KW - Prospective Studies
KW - Renal Insufficiency, Chronic
KW - Smoking
KW - Journal Article
KW - Observational Study
U2 - 10.1053/j.ajkd.2016.02.052
DO - 10.1053/j.ajkd.2016.02.052
M3 - Journal article
C2 - 27118687
SN - 0272-6386
VL - 68
SP - 371
EP - 380
JO - American journal of kidney diseases : the official journal of the National Kidney Foundation
JF - American journal of kidney diseases : the official journal of the National Kidney Foundation
IS - 3
ER -