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Cited by 86Smoking Behavior and CessationChronic Kidney Disease and DiabetesChronic Obstructive Pulmonary Disease (COPD) Research

Smoking and adverse outcomes in patients with CKD: The Study of Heart and Renal Protection (SHARP)

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Staplin, Natalie, Haynes, Richard, Herrington, William G., Reith, Christina, Cass, Alan, Fellström, Bengt, Jiang, Lixin, Kasiske, Bertram L. +58 more·2016·American Journal of Kidney Diseases
DOI 10.1053/j.ajkd.2016.02.052PMC PMC4996629
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Abstract

BACKGROUND: 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±0.07mL/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. 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.

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  • Although no RCTs have examined the impact of smoking cessation on cardiovascular risk in those with CKD, observational studies have highlighted the harmful cardiovascular effects associated with smoking.

    “Although no RCTs have examined the impact of smoking cessation on cardiovascular risk in those with CKD, observational studies have highlighted the harmful cardiovascular effects associated with smoking.”

    From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [181]

    The Results and Discussion (page not available in our copy) report higher vascular-event risk among smokers with CKD, supporting the observational finding. The Discussion says this analysis could not directly assess smoking cessation, but the paper does not establish the broader claim that no RCTs have examined cessation’s effect on cardiovascular risk in CKD. (LLM, conf=0.86)

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References 43 · Cited by 86

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  1. [1]Lim S.S. Vos T. Flaxman A.D. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 Lancet 380 9859 2012 2224 2260 23245609 PMC4156511
  2. [3]Doll R. Peto R. Wheatley K. Gray R. Sutherland I. Mortality in relation to smoking: 40 years' observations on male British doctors BMJ 309 6959 1994 901 911 7755693 PMC2541142
  3. [4]Pirie K. Peto R. Reeves G.K. Green J. Beral V. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK Lancet 381 9861 2013 133 141 23107252 PMC3547248
  4. [5]Carter B.D. Abnet C.C. Feskanich D. Smoking and mortality–beyond established causes N Engl J Med 372 7 2015 631 640 25671255
  5. [6]Yamagata K. Ishida K. Sairenchi T. Risk factors for chronic kidney disease in a community-based population: a 10-year follow-up study Kidney Int 71 2 2007 159 166 17136030
  6. [7]Vajdic C.M. McDonald S.P. McCredie M.R. Cancer incidence before and after kidney transplantation JAMA 296 23 2006 2823 2831 17179459
  7. [8]Matsushita K. van der Velde M. Astor B.C. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis Lancet 375 9731 2010 2073 2081 20483451 PMC3993088
  8. [9]Gansevoort R.T. Matsushita K. van der Velde M. Lower estimated GFR and higher albuminuria are associated with adverse kidney outcomes. A collaborative meta-analysis of general and high-risk population cohorts Kidney Int 80 1 2011 93 104 21289597 PMC3959732
  9. [10]Foley R.N. Herzog C.A. Collins A.J. Smoking and cardiovascular outcomes in dialysis patients: the United States Renal Data System Wave 2 Study Kidney Int 63 4 2003 1462 1467 12631362
  10. [11]Baigent C. Landray M.J. Reith C. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial Lancet 377 9784 2011 2181 2192 21663949 PMC3145073
  11. [12]Grams M.E. Coresh J. Segev D.L. Kucirka L.M. Tighiouart H. Sarnak M.J. Vascular disease, ESRD, and death: interpreting competing risk analyses Clin J Am Soc Nephrol 7 10 2012 1606 1614 22859747 PMC3463208
  12. [13]Ricardo A.C. Anderson C.A. Yang W. Healthy lifestyle and risk of kidney disease progression, atherosclerotic events, and death in CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study Am J Kidney Dis 65 3 2015 412 424 25458663 PMC4339665
  13. [16]SHARP Collaborative Group Effects of lowering LDL cholesterol on progression of kidney disease J Am Soc Nephrol 25 8 2014 1825 1833 24790178 PMC4116066
  14. [17]Plummer M. Improved estimates of floating absolute risk Stat Med 23 1 2004 93 104 14695642
  15. [19]Herzog C.A. How to manage the renal patient with coronary heart disease: the agony and the ecstasy of opinion-based medicine J Am Soc Nephrol 14 10 2003 2556 2572 14514733
  16. [20]Shlipak M.G. Fried L.F. Cushman M. Cardiovascular mortality risk in chronic kidney disease: comparison of traditional and novel risk factors JAMA 293 14 2005 1737 1745 15827312
  17. [21]Muntner P. He J. Astor B.C. Folsom A.R. Coresh J. Traditional and nontraditional risk factors predict coronary heart disease in chronic kidney disease: results from the Atherosclerosis Risk in Communities Study J Am Soc Nephrol 16 2 2005 529 538 15625072
  18. [22]Parish S. Collins R. Peto R. Cigarette smoking, tar yields, and non-fatal myocardial infarction: 14,000 cases and 32,000 controls in the United Kingdom. The International Studies of Infarct Survival (ISIS) Collaborators BMJ 311 7003 1995 471 477 7647641 PMC2550542
  19. [23]Teo K.K. Ounpuu S. Hawken S. Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study Lancet 368 9536 2006 647 658 16920470
  20. [24]Clarke R. Emberson J. Fletcher A. Breeze E. Marmot M. Shipley M.J. Life expectancy in relation to cardiovascular risk factors: 38 year follow-up of 19 000 men in the Whitehall study BMJ 339 2009 b3513 19762417 PMC2746269
  21. [25]Wong G. Hayen A. Chapman J.R. Association of CKD and cancer risk in older people J Am Soc Nephrol 20 6 2009 1341 1350 19406977 PMC2689896
  22. [26]Lowrance W.T. Ordonez J. Udaltsova N. Russo P. Go A.S. CKD and the risk of incident cancer J Am Soc Nephrol 25 10 2014 2327 2334 24876115 PMC4178430
  23. [27]Chase H.P. Garg S.K. Marshall G. Cigarette smoking increases the risk of albuminuria among subjects with type I diabetes JAMA 265 5 1991 614 617 1987411
  24. [28]Omvik P. How smoking affects blood pressure Blood Press 5 2 1996 71 77 9162447
  25. [29]Benck U. Clorius J.H. Zuna I. Ritz E. Renal hemodynamic changes during smoking: effects of adrenoreceptor blockade Eur J Clin Invest 29 12 1999 1010 1018 10583448
  26. [30]Halimi J.M. Giraudeau B. Vol S. Effects of current smoking and smoking discontinuation on renal function and proteinuria in the general population Kidney Int 58 3 2000 1285 1292 10972692
  27. [31]Pinto-Sietsma S.J. Mulder J. Janssen W.M. Hillege H.L. de Zeeuw D. de Jong P.E. Smoking is related to albuminuria and abnormal renal function in nondiabetic persons Ann Intern Med 133 8 2000 585 591 11033585
  28. [32]Cole S.R. Platt R.W. Schisterman E.F. Illustrating bias due to conditioning on a collider Int J Epidemiol 39 2 2010 417 420 19926667 PMC2846442
  29. [33]Snyder J.J. Foley R.N. Collins A.J. Prevalence of CKD in the United States: a sensitivity analysis using the National Health and Nutrition Examination Survey (NHANES) 1999-2004 Am J Kidney Dis 53 2 2009 218 228 18950914 PMC2664624
  30. [34]Lin B. Shao L. Luo Q. Prevalence of chronic kidney disease and its association with metabolic diseases: a cross-sectional survey in Zhejiang province, Eastern China BMC Nephrol 15 1 2014 36 24559433 PMC3936864
  31. [35]Varma P.P. Raman D.K. Ramakrishnan T.S. Singh P. Varma A. Prevalence of early stages of chronic kidney disease in apparently healthy central government employees in India Nephrol Dial Transplant 25 9 2010 3011 3017 20233739
  32. [36]Rao A. Steenkamp R. Caskey F. UK Renal Registry 16th annual report: chapter 5 comorbidities and current smoking status amongst patients starting renal replacement therapy in England, Wales and Northern Ireland from 2011 to 2012 Nephron Clin Pract 125 1-4 2013 99 110 24662169
  33. [37]Zhang L. Wang F. Wang L. Prevalence of chronic kidney disease in China: a cross-sectional survey Lancet 379 9818 2012 815 822 22386035
  34. [38]Jha P. Ramasundarahettige C. Landsman V. 21st-Century hazards of smoking and benefits of cessation in the United States N Engl J Med 368 4 2013 341 350 23343063
  35. [39]Duffy S.W. Maximovitch D.M. Day N.E. External validation, repeat determination, and precision of risk estimation in misclassified exposure data in epidemiology J Epidemiol Community Health 46 6 1992 620 624 1494080 PMC1059681

Authors
Staplin, N., Haynes, R., Herrington, W. G., Reith, C., Cass, A., Fellström, B., Jiang, L., Kasiske, B. L., Krane, V., Levin, A., Walker, R., Wanner, C., Wheeler, D. C., Landray, M. J., Baigent, C., Emberson, J., Baigent, C., Landray, M. J., Reith, C., Emberson, J., Wheeler, D. C., Tomson, C., Wanner, C., Krane, V., Cass, A., Craig, J., Neal, B., Jiang, L., Hooi, L. S., Levin, A., Agodoa, L., Gaziano, M., Kasiske, B. L., Walker, R., Massy, Z. A., Feldt-Rasmussen, B., Krairittichai, U., Ophascharoensuk, V., Fellström, B., Holdaas, H., Tesar, V., Wiecek, A., Grobbee, D., de Zeeuw, D., Grönhagen-Riska, C., Dasgupta, T., Lewis, D., Herrington, W. G., Mafham, M., Majoni, W., Wallendszus, K., Grimm, R., Pedersen, T., Tobert, J., Armitage, J., Baxter, A., Bray, C., Chen, Y., Chen, Z., Hill, M., Knott, C., Parish, S., Simpson, D., Sleight, P., Young, A., & Collins, R.
Affiliations
  • University of Oxford (GB)
  • University College London (GB)
  • Menzies School of Health Research (AU)
ORCID
Venue
American Journal of Kidney Diseases
Publisher
Elsevier BV
Published
2016-09
Volume
68
Issue
3
Pages
371-380
ISSN
0272-6386 (ISSN-L)
DOI
10.1053/j.ajkd.2016.02.052
PMC
PMC4996629
OpenAlex
W2340386927
Cited by
86
References
43
Citations by year
2026: 7 · 2025: 7 · 2024: 9 · 2023: 7 · 2022: 6 · 2021: 13 · 2020: 7 · 2019: 7 · 2018: 8 · 2017: 6 · 2016: 9
FWCI
8.05
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Kidney Diseases (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
  • UCL Discovery (University College London) (submittedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Funders
  • Merck/Schering-Plough Pharmaceuticals
  • Australian National Health Medical Research Council, the British Heart Foundation
  • UK Medical Research Council
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
Keywords
smoking, chronic kidney disease, cardiovascular events, cancer incidence, end-stage renal disease, estimated glomerular filtration rate decline, mortality, atherosclerosis, lung cancer, upper aerodigestive tract cancer, SHARP trial, smoking cessation, cardiovascular risk stratification, kidney disease progression, cardiovascular risk prediction models, renal protection, cardiovascular risk reduction, cardiovascular risk
MeSH terms
Cardiovascular Diseases, Female, Heart Diseases, Humans, Kidney Failure, Chronic, Male, Middle Aged, Prospective Studies, Smoking, Disease Progression, Renal Insufficiency, Chronic

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