The following is a summary of “Cigarette smoking and adverse health outcomes in patients treated with maintenance dialysis,” published in the January 2023 issue of Nephrology by Bek, et al.


It is well-known that smoking is linked to mortality in dialysis patients asand newly developing cardiovascular disease, chronic lung disease, and cancer. For a study, researchers sought to analyze how common smoking was and if it affected patient outcomes.

In a multicenter cohort research utilizing the “ANZDATA” Registry, 57,838 persons who began dialysis (>3 months) between 1990 and 2016 were included. The existence of comorbid conditions, the first dialysis modality, the patient’s demographics, and smoking history were predictive. Mortality from all causes was the key result. Secondary outcomes included smoking prevalence, cause-specific mortality, non-skin malignancies, cardiovascular illnesses, and chronic lung conditions.

Over 56,512 of the 57,838 patients (mean age 58.9±15.1 years, 40.1% female, 43% diabetic) had data on their smoking history, with 13.6% currently smoking, 40.7% formerly, and 45.6% never smoking. A 10% (HR 1.10; 95% CI: 1.08, 1.13) and a 22% (HR 1.22; 95% CI: 1.18, 1.26) increased risk of all-cause death, respectively, was associated with former and current smokers. They were 13% (HR 1.13; 95% CI: 1.09, 1.18) and 23% (HR 1.23; 95% CI: 1.17, 1.29) for CVD mortality, respectively. Both present and previous smokers had increased rates of respiratory failure mortality when they smoked (HR 1.59; 95% CI: 1.13, 2.23; P =.073 and HR 1.33; 95% CI: 1.01, 1.74; P =.042). Smokers had a greater risk of developing non-skin cancer both currently and in the past (HR 1.30; 95% CI: 1.19, 1.42 and HR 1.24; 95% CI: 1.17, 1.32). Smoking was linked to a greater risk of death from chronic lung disease (HR 1.48; 95% CI 1.15-1.92), which was also linked to a higher risk of death from cancer (HR 1.26; 95% CI 1.19-1.33). In terms of de novo vascular disease (PVD, CVD), CAD, former and current smokers had a higher adjusted risk (adjusted RR 1.1; 95% Cl: 1.09-1.12).

Smoking was linked to increased risks of non-skin cancers, de novo vascular disease, chronic lung disease, all-cause mortality, cardiovascular mortality, respiratory failure, chronic lung disease, and malignancy among dialysis patients.

Reference: onlinelibrary.wiley.com/doi/10.1111/nep.14122