Smoking and Adverse Outcomes in Patients With CKD: The Study of Heart and Renal Protection (SHARP)

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• 作者：Natalie Staplin ; PhD¹ ; ^&lowast ; ; Richard Haynes ; DM¹ ; ^&lowast ; ; William G. Herrington ; MD¹ ; Christina Reith ; FRCP¹ ; Alan Cass ; FRACP² ; Bengt Fellströ ; m ; MD³ ; Lixin Jiang ; MD⁴ ; Bertram L. Kasiske ; MD⁵ ; Vera Krane ; MD⁶ ; Adeera Levin ; FRCPC⁷ ; Robert Walker ; FRACP⁸ ; Christoph Wanner ; MD⁶ ; David C. Wheeler ; FRCP⁹ ; Martin J. Landray ; PhD¹ ; Colin Baigent ; FRCP¹ ; ^{colin.baigent@ctsu.ox.ac.uk" class="auth_mail" title="E-mail the corresponding author} ; Jonathan Emberson ; PhD¹ ; ^{jonathan.emberson@ctsu.ox.ac.uk" class="auth_mail" title="E-mail the corresponding author} ; on behalf of the SHARP Collaborative Group^&dagger ; ; 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 Fellströ ; m ; Hallvard Holdaas ; Vladimir Tesar ; Andrzej Wiecek ; Diederick Grobbee ; Dick de Zeeuw ; Carola Grö ; nhagen-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
• 关键词：Cigarette smoking ; tobacco ; chronic kidney disease (CKD) ; vascular morbidity ; end-stage renal disease (ESRD) ; risk factor ; cause-specific mortality ; vascular events ; cancer ; estimated glomerular filtration rate (eGFR) ; disease progression ; Study of Heart and Renal Protection (SHARP)
• 刊名：American Journal of Kidney Diseases
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：68
• 期：3
• 页码：371-380
• 全文大小：279 K

文摘

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 ± 0.07 mL/min/1.73 m² 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.