Title |
Smoking and Adverse Outcomes in Patients With CKD: The Study of Heart and Renal Protection (SHARP)
|
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Published in |
American Journal of Kidney Diseases, April 2016
|
DOI | 10.1053/j.ajkd.2016.02.052 |
Pubmed ID | |
Authors |
Natalie Staplin, Richard Haynes, William G. Herrington, Christina Reith, Alan Cass, Bengt Fellström, Lixin Jiang, Bertram L. Kasiske, Vera Krane, Adeera Levin, Robert Walker, Christoph Wanner, David C. Wheeler, Martin J. Landray, Colin Baigent, Jonathan Emberson, SHARP Collaborative Group, Colin Baigent, Martin J. Landray, Christina Reith, Jonathan Emberson, David C. Wheeler, Charles Tomson, Christoph Wanner, Vera Krane, Alan Cass, Jonathan Craig, Bruce Neal, Lixin Jiang, Lai Seong Hooi, Adeera Levin, Lawrence Agodoa, Mike Gaziano, Bertram L. Kasiske, Robert Walker, Ziad A. Massy, Bo Feldt-Rasmussen, Udom Krairittichai, Vuddidhej Ophascharoensuk, Bengt Fellström, Hallvard Holdaas, Vladimir Tesar, Andrzej Wiecek, Diederick Grobbee, Dick de Zeeuw, Carola Grönhagen-Riska, Tanaji Dasgupta, David Lewis, William G. Herrington, Marion Mafham, William Majoni, Karl Wallendszus, Richard Grimm, Terje Pedersen, Jonathan Tobert, Jane Armitage, Alex Baxter, Christopher Bray, Yiping Chen, Zhengming Chen, Michael Hill, Carol Knott, Sarah Parish, David Simpson, Peter Sleight, Alan Young, Rory Collins |
Abstract |
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. Observational study. 9,270 participants with CKD enrolled in SHARP. Baseline smoking status (current, former, and never). Vascular events, site-specific cancer, ESRD, rate of change in estimated glomerular filtration rate (eGFR), and cause-specific mortality. 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. Smoking status not assessed during follow-up. 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. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United States | 2 | 18% |
United Kingdom | 1 | 9% |
Finland | 1 | 9% |
Canada | 1 | 9% |
Switzerland | 1 | 9% |
Unknown | 5 | 45% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 7 | 64% |
Practitioners (doctors, other healthcare professionals) | 3 | 27% |
Science communicators (journalists, bloggers, editors) | 1 | 9% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 109 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Master | 16 | 15% |
Researcher | 12 | 11% |
Student > Bachelor | 9 | 8% |
Other | 8 | 7% |
Lecturer | 6 | 6% |
Other | 23 | 21% |
Unknown | 35 | 32% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 38 | 35% |
Nursing and Health Professions | 8 | 7% |
Psychology | 4 | 4% |
Biochemistry, Genetics and Molecular Biology | 3 | 3% |
Environmental Science | 3 | 3% |
Other | 12 | 11% |
Unknown | 41 | 38% |