A randomized clinical trial to determine the effectiveness of CO-oximetry and anti-smoking brief advice in a cohort of kidney transplant patients who smoke: study protocol for a randomized controlled trial

Abstract

BackgroundThe cardiovascular risk in renal transplant patients is increased in patients who continue to smoke after transplantation.The aim of the study is to measure the effectiveness of exhaled carbon monoxide (CO) measurement plus brief advisory sessions, in comparison to brief advice, to reduce smoking exposure and smoking behavior in kidney transplant recipients who smoke. The effectiveness will be measured by: (1) abandonment of smoking, (2) increase in motivation to stop smoking, and (3) reduction in the number of cigarettes smoked per day.Methods/designDesign: a randomized, controlled, open clinical trial with blinded evaluation.Scope: A Coruña Hospital (Spain), reference to renal transplantation in the period 2012–2015.Inclusion criteria: renal transplant patients who smoke in the precontemplation, contemplation or preparation stages according to the Prochaska and DiClemente’s Stages of Change model, and who give their consent to participate.Exclusion criteria: smokers attempting to stop smoking, patients with terminal illness or mental disability that prevents them from participating.Randomization: patients will be randomized to the control group (brief advisory session) or the intervention group (brief advisory session plus measuring exhaled CO). The sample target size is n = 112, with 56 patients in each group. Allowing for up to 10 % loss to follow-up, this would provide 80 % power to detect a 13 % difference in attempting to give up smoking outcomes at a two-tailed significance level of 5 %. Measurements: sociodemographic characteristics, cardiovascular risk factors, treatment, rejection episodes, infections, self-reported smoking habit, drug use, level of dependence (the Fagerström test), stage of change (Prochaska and DiClemente’s Stages of Change model), and motivation to giving up smoking (the Richmond test).Response: the effectiveness will be evaluated every 3, 6, 9 and 12 months as: pattern of tobacco use (self-reported tobacco use), smoking cessation rates, carbon monoxide (CO) levels in exhaled air measured by CO-oximetry, urinary cotinine tests, nicotine dependence (Fagerström test), motivational stages of change (Prochaska and DiClemente’s stages) and motivation to stop smoking (the Richmond test).Analysis: descriptive statistics and linear/logistic multiple regression models will be performed. Clinical relevance will be measured as relative risk reduction, absolute risk reduction and the number needed to treat.Ethics: informed consent of the patients and Ethical Review Board was obtained (code 2011/061).DiscussionTobacco is a modifiable risk factor that increase the risk of morbidity and mortality in kidney transplant recipients. If effectiveness of CO-oximetry is confirmed to reduce tobacco exposure, we would have an intervention that is easy to use, low cost and with great implications about cardiovascular risk prevention in these patients.Trial registrationCurrent Controlled Trials ISRCTN16615772.EudraCT number: 2015-002009-12.

Posttransplant Medical Adherence: What Have We Learned and Can We Do Better?

“…We have been unable to identify any studies evaluating interventions to reduce risk of tobacco, alcohol, or other substance use in kidney recipients. A published protocol described a trial testing a non-pharmacologic intervention (brief counseling plus feedback on patients’ carbon monoxide oximetry) in order to promote smoking cessation in kidney recipients [74]. However, no results have yet been reported.…”

Cigarette Smoking and Its Hazards in Kidney Transplantation

“…No relation was found between smoking and rejection by Kheradmand and Shahbazian [ 38 ]. An open randomized trial is currently being conducted to determine the effectiveness of carbon monoxide-oximetry and anticigarette smoking counselling in a cohort of kidney transplant patients who smoke [ 58 ]. This randomized open label study will assess its effectiveness on cessation of cigarette smoking and will measure various outcomes including rejection.…”

“…An ongoing open label randomized control trial in kidney transplant recipients is under way. Recipient will be followed up for 1 year to assess effectiveness of smoking cessation and the study will measure various variable including infections [ 58 ]. This study may provide more evidence for relationship of smoking with infection in the future.…”

Randomized clinical trial to determine the effectiveness of CO-oximetry and anti-smoking brief advice in a cohort of kidney transplant patients who smoke

“…The design of this study was previously published [26] in accordance with CONSORT guidelines. Participant flow chart is shown in Fig 1. Briefly, smoker patients who met eligibility criteria were recruited in the scheduled routine visits to the hospital and informed about the study objectives.…”