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Dialysis patients who smoke die earlier

28 July 2016

They also are less likely to get a transplant according to new research conducted at University Limerick which is co-funded by the Health Research Board and the Irish Heart Foundation.

“Smoking remains a major modifiable risk factor for adverse outcomes for men and women on dialysis. It shortens their lifespans and reduces their overall chances of kidney transplantation," according to Professor Austin Stack MD, Lead author, Consultant Nephrologist at UL Hospitals and Director of UL Health Research Institute (HRI).

Dr Graham Love, Chief Executive at the Health Research Board says, "Research saves lives. This study illustrates how a change in behaviour, stopping smoking, could reduce premature death among dialysis patients."

The study, just published online in the journal BMC Nephrology assessed the impact of smoking among new dialysis patients and evaluated the extent to which it affected overall mortality rates and rates of kidney transplantation. Using data from the US Renal Registry, the team followed 1,220,000 patients who began dialysis in the United States from 1995 to 2010 for an average for 2 years.  

Among the major findings included: -

  • Smokers were significantly more likely to die than non-smokers and this adverse risk was equally present for both men and women
  • Smoking had a far greater negative impact on the lifespans of younger men and women than among older patients
  • Smoking was associated with higher death rates for all patients but the adverse impact was far greater for those with pre-existing cardiovascular conditions including coronary disease, stroke and peripheral vascular disease
  • Smokers were significantly less likely to receive a kidney transplant than non-smokers and this adverse risk was equally present for both men and women
  • Smokers with pre-existing cardiovascular conditions had the lowest risk of receiving a kidney transplant
  • The relationship of smoking with higher death rates and lower kidney transplantation rates was not explained by concurrent illness, socioeconomic status, or differences in care provided to patients prior to or after initiating dialysis. 

“Dialysis patients have extremely high premature death rates that are between 10- and 100-fold higher than in the general population, and smoking contributes substantially to lower patient survival,” said Professor Stack.

“Smoking is a well-known risk factor for death and disability for patients in the general population.  Our study, one of the largest ever conducted, found that smokers have alarmingly high rates of premature death. Quite strikingly, the risks of death were far greater in younger men and younger women than in older patients. Equally concerning, dialysis patient who smoked experienced lower rates of kidney transplantation and the chance to extend survival and quality of life.  These risks were considerable in that smokers were between 26% and 50% less likely to receive a kidney transplant taking all other factors into consideration."

“Smoking is a major risk amplifier for patients on dialysis,” concludes Prof Stack. "Consequently, we believe that kidney specialists and all healthcare providers should engage with their patients to pursue smoking cessation strategies at every opportunity”. 

You can read the full press release at the link below.

You can read the full study, Differential Impact of Smoking on Mortality and Kidney Transplantation among adult Men and Women undergoing Dialysis, at the link below.

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