Association of Smoking with Cardiovascular and Infection-Related Morbidity and Mortality in Chronic Hemodialysis

Causland, Finnian R. Mc; Brunelli, Steven M.; Waikar, Sushrut S.

doi:10.2215/cjn.03880412

Cited by 16 publications

(13 citation statements)

References 39 publications

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“…Natural killer cells and immunoglobulin (IgA, IgG, and IgM) levels are also reduced in smokers, which will reduce immune threshold further [ 71 – 73 ]. Tobacco use is an independent predictor of all-cause and infection-related mortality in hemodialysis patients [ 74 , 75 ]. Keeping these factors in mind, kidney transplant recipients with reduced immunity will be at more risk of developing infections.…”

Section: Cigarette Smoking and Kidney Recipientmentioning

confidence: 99%

Cigarette Smoking and Its Hazards in Kidney Transplantation

Khalil¹,

Tan

Khamis³

et al. 2017

Advances in Medicine

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Cigarette smoking affects many organs. It causes vasoconstriction through activation of sympathetic nervous system which leads to elevation of blood pressure and reduction in glomerular filtration rate and filtration pressure. It also causes thickening of renal arterioles. Cigarette smoking increases the risk of microalbuminuria and accelerates progression of microalbuminuria to macroalbuminuria. Furthermore, it causes rapid loss of glomerular filtration rate in chronic kidney disease patients. After kidney donation, these factors may be injurious to the solitary kidney. Kidney donors with history of cigarette smoking are prone to develop perioperative complications, pneumonia, and wound infection. Postkidney transplantation various stressors including warm and cold ischemia time, delayed graft function, and exposure to calcineurin inhibitors may result in poor graft function. Continuation of cigarette smoking in kidney transplant recipients will add further risk. In this review, we will specifically discuss the effects of cigarette smoking on normal kidneys, live kidney donors, and kidney transplant recipients. This will include adverse effects of cigarette smoking on graft and patient survival, cardiovascular events, rejection, infections, and cancers in kidney transplant recipients. Lastly, the impact of kidney transplantation on behavior and smoking cessation will also be discussed.

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Section: Cigarette Smoking and Kidney Recipientmentioning

confidence: 99%

Cigarette Smoking and Its Hazards in Kidney Transplantation

Khalil¹,

Tan

Khamis³

et al. 2017

Advances in Medicine

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“…There are limited studies in the literature that have explored the relationship of smoking with clinical outcomes among incident dialysis cohorts. While, previous studies have demonstrated that smoking is associated with adverse clinical outcomes, most of these have considered smoking as an adjustment variable rather than the primary exposure [ 10 – 15 ]. Furthermore, to our knowledge, only a single published study has explored risks of smoking among dialysis patients with pre-existing atherosclerotic disease [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…The current body of evidence would suggest that tobacco use is an independent predictor of all-cause and infection-related mortality [ 11 , 13 – 15 ] and de-novo vascular disease [ 10 ]. However, it has been unclear until now the extent to which smoking contributes to death and transplantation in men and in women with atherosclerotic disease and across different age categories.…”

Section: Discussionmentioning

confidence: 99%

“…The extent to which these conditions contribute to elevated death risk is determined by the effectiveness of cardiovascular treatment strategies and the degree to which existing atherosclerotic risk factors are controlled [ 7 , 8 , 9 ]. Despite these facts, it is surprising that only few studies exist that have addressed the clinical significance of smoking, an established modifiable risk factor, on clinical outcomes among patients with ESKD, [ 10 – 15 ]. The evidence to date would suggest that smoking among patients who require dialysis is associated with accelerated atherosclerosis and increased mortality.…”

Section: Introductionmentioning

confidence: 99%

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Differential impact of smoking on mortality and kidney transplantation among adult Men and Women undergoing dialysis

et al. 2016

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BackgroundThe extent to which smoking contributes to adverse outcomes among men and women of all ages undergoing dialysis is uncertain. The objective of this study was to determine the differential impact of smoking on risks of mortality and kidney transplantation by age and by sex at dialysis initiation.MethodsWe conducted a population-based cohort of incident U.S dialysis patients (n = 1, 220, 000) from 1995–2010. Age- and sex-specific mortality and kidney transplantation rates were determined for patients with and without a history of cardiovascular disease. Multivariable Cox regression evaluated relative hazard ratios (HR) for death and kidney transplantation at 2 years stratified by atherosclerotic condition, smoking status and age. Analyses were adjusted for demographic characteristics, non-cardiovascular conditions, laboratory variables, socioeconomic and lifestyle factors.ResultsThe average age was 62.8 (±15) years old, 54 % were male, and the majority was white. During 2-year follow-up, 40.5 % died and 5.7 % were transplanted. Age- and sex-specific mortality rates were significantly higher while transplantation rates were significantly lower for smokers with atherosclerotic conditions than non-smokers (P < 0.01). The adjusted mortality hazards were significantly higher for smokers with pre-existing coronary disease (HR 1.15, 95 % CI (1.11–1.18), stroke (HR 1.21, 1.16–1.27) and peripheral vascular disease (HR = 1.21, 1.17–1.25) compared to non-smokers without these conditions (HR 1.00, referent group). The magnitude of effect was greatest for younger patients than older patients. Contrastingly, the adjusted risks of kidney transplantation were significantly lower for smokers with coronary disease: (HR 0.60, 0.52–0.69), stroke; (HR 0.47, 0.37–0.60), and peripheral arterial disease (HR 0.55, 0.46–0.66) respectively compared to non-smokers without these conditions.ConclusionsWe provide compelling evidence that smoking is associated with adverse clinical outcomes and reduced lifespans among dialysis patients of all ages and sexes. The adverse impact is greatest for younger men and women.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0311-x) contains supplementary material, which is available to authorized users.

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“…Finally, observational studies have documented a higher cardiovascular mortality and hospitalization rate in hemodialysis patients who were current smokers than patients who never smoked, with intermediate rates seen in former smokers. 30 Statins consistently reduce cardiovascular events in the general population in both primary and secondary prevention. 31 The frequency of cardiac events is far greater in dialysis patients than the general population, which might translate into an enormous benefit of statins.…”

Section: Medical Management Of Coronary Artery Diseasementioning

confidence: 99%

Evidence-Based Cardiology in Hemodialysis Patients

Allon

2013

Journal of the American Society of Nephrology

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Cardiac events are the major cause of death in hemodialysis patients. Because of the paucity of randomized clinical trials (RCTs) in hemodialysis patients, most cardiovascular therapies in this population are based on observational studies or results extrapolated from studies that excluded hemodialysis patients. However, associations discovered in observational studies do not prove causality, and these studies often report surrogate outcomes rather than clinical end points. Furthermore, interventions that show effectiveness in the general population may have drastically different outcomes and side effect profiles in hemodialysis patients. This review discusses the results of RCTs undertaken recently to evaluate cardiovascular therapies in hemodialysis patients and emphasizes clinically relevant outcomes. Although some interventions have produced similar outcomes in hemodialysis patients and the general population, others have not, suggesting that the management of cardiovascular disease in hemodialysis patients may require strategies that differ from the best practice guidelines applied to general population.

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Association of Smoking with Cardiovascular and Infection-Related Morbidity and Mortality in Chronic Hemodialysis

Cited by 16 publications

References 39 publications

Cigarette Smoking and Its Hazards in Kidney Transplantation

Cigarette Smoking and Its Hazards in Kidney Transplantation

Differential impact of smoking on mortality and kidney transplantation among adult Men and Women undergoing dialysis

Evidence-Based Cardiology in Hemodialysis Patients

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