Active Smoking is Associated with Lower Dialysis Adequacy in Prevalent Dialysis Patients
Active smoking and dialysis adequacy
Abstract
BACKGROUND: Dialysis adequacy measured by single pool Kt/V (spKt/V) lower than 1.2 or urea reduction rate (URR) lower than 65% is associated with a significant increase in patient mortality rate. Patients’ adherence to the medical treatment is crucial to achieve recommended targets for spKt/V. Smoking is a recognized factor of non-adherence.
AIM: In this study we sought to assess the association of active smoking and dialysis adequacy.
METHODS: A total of 134 prevalent dialysis patients from one dialysis center were included in an observational cross-sectional study. Clinical, laboratory and dialysis data were obtained from medical charts in previous 6 months. The number of missed, on purpose interrupted or prematurely terminated dialysis sessions was obtained. Dialysis adequacy was calculated as spKt/V and URR. Patients were questioned about current active smoking status. T-test and Chi-Square test were used for comparative analysis of dialysis adequacy with regard to smoking status.
RESULTS: The majority of patients declared a non-smoking status (100 (75%)) and 34 (25%) were active smokers. Male gender, younger age and shorter dialysis vintage were significantly more often present in the active smokers ((9 (26%) vs 25 (73%), p = 0.028; 57.26 ± 12.59 vs 50.15 ± 14.10, p = 0.012; 118.59 ± 76.25 vs 88.82 ± 57.63, p = 0.030)), respectively. spKt/V and URR were significantly lower and Kt/V target was less frequently achieved in smokers ((1.46 ± 0.19 vs. 1.30 ± 0.021, p = 0.019; 67.14 ± 5.86 vs. 63.64 ± 8.30, p = 0.002; 14 (14%) vs. 11 (32%), p = 0.023), respectively. Shorter dialysis sessions, larger ultra filtrations and higher percentage of missed/interrupted dialysis session on patients’ demand were observed in smokers (4.15 ± 0.30 vs. 4.05 ± 0.17, p = 0.019; 3.10 ± 0.78 vs. 3.54 ± 0.92, p = 0.017; 25 (0.3%) vs. 48 (1.8%), p = 0.031), respectively.
CONCLUSION: Active smokers, especially younger men, achieve lower than the recommended levels for dialysis adequacy. Non-adherence to treatment prescription in smokers is a problem to be solved. Novel studies are recommended in patients on dialysis, to further elucidate the association of dialysis adequacy with the active smoking status.
Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Collins AJ, Ma JZ, Umen A, Keshaviah P. Urea index and other predictors of hemodialysis patient survival. Am J Kidney Dis. 1994; 23:272-82. https://doi.org/10.1016/S0272-6386(12)80984-X
Capelli JP, Kushner H, Camiscioli T, Chen SM, Stuccio-White NM. Factors affecting survival of hemodialysis patients utilizing urea kinetic modeling. A critical appraisal of shortening dialysis times. Am J Nephrol. 1992; 12:212-23. https://doi.org/10.1159/000168449 PMid:1481868
Lowrie EG, Laird NM, Parker TF, Sargent JA. Effect of the hemodialysis prescription on patient morbidity: Report from the National Cooperative Dialysis Study. N Engl J Med. 1981; 305:1176-81. https://doi.org/10.1056/NEJM198111123052003 PMid:7027040
Borzou SR, Gholyaf M, Zandiha M, Amini R, Goodarzi MT, Torkaman B. The effect of increasing blood flow rate on dialysis adequacy in hemodialysis patients. Saudi J Kidney Dis Transpl. 2009; 20:639-42.
Port FK, Rasmussen CS, Leavey SF, Wolfe RA, Kurokawa K, Akizawa T. Association of blood flow rate and treatment time with mortality risk in HD patients across three continents. J Am SocNephrol. 2001; 12:343-4.
III NKF-K/DOQI Clinical practice guidelines for vascular access: Update 2000. Am J Kidney Dis. 2001; 37(1):137-81. https://doi.org/10.1016/S0272-6386(01)70007-8
Rahman M, Fu P, Sehgal AR, Smith MC. Interdialytic weight gain, compliance with dialysis regimen, and age are independent predictors of blood pressure in hemodialysis patients. Am J Kidney Dis. 2000; 35:257-65. https://doi.org/10.1016/S0272-6386(00)70335-0
Lowrie EG, Laird NM, Parker TF, Sargent JA. Effect of the hemodialysis prescription on patient morbidity: Report from the National Cooperative Dialysis Study. N Engl J Med. 1981; 305:1176-81. https://doi.org/10.1056/NEJM198111123052003 PMid:7027040
Stengel B, Tarver-Carr M, Powe N, Eberhardt M, Brancati F. Lifestyle Factors, Obesity and the Risk of Chronic Kidney Disease. Epidemiology. 2003; 14(4):479-87. https://doi.org/10.1097/01.EDE.0000071413.55296.c4 PMid:12843775
Yacoub R, Habib H, Lahdo A, Al Ali R, Varjabedian L, Atalla G, Akl NK, Aldakheel S, Alahdab S, Albitar S. Association between smoking and chronic kidney disease: a case control study. BMC public health. 2010; 10(1):731. https://doi.org/10.1186/1471-2458-10-731 PMid:21108832 PMCid:PMC3004836
Kutner NG, Zhang R, McClellan WM, Cole SA. Psychosocial predictors of non-compliance in haemodialysis and peritoneal dialysis patients. Nephrol Dial Transplant. 2002; 17(1):93-9. https://doi.org/10.1093/ndt/17.1.93 PMid:11773470
Tohme F, Mor MK, Pena-Polanco J, et al. Predictors and outcomes of non-adherence in patients receiving maintenance hemodialysis. IntUrolNephrol. 2017; 49(8):1471-79. https://doi.org/10.1007/s11255-017-1600-4 PMid:28455663 PMCid:PMC5522640
Orth SR, Uehlinger DE. Smoking and dialysis: A dreadful scenario for the cardiovascular system?. Kidney international. 2003; 63(4):1580-1. https://doi.org/10.1046/j.1523-1755.2003.00894.x PMid:12631377
Liebman, Scott E, Steven P et al. Smoking in Dialysis Patients: A Systematic Review and Meta-analysis of Mortality and Cardiovascular Morbidity. Am J Kidney Dis. 2011; 58(2):257-65. https://doi.org/10.1053/j.ajkd.2011.03.025 PMid:21664017 PMCid:PMC3247014
Kramer A, Pippias A, Noordzij M, et al. The European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report 2015: a summary. Clin Kidney J. 2018; 11(1):108-122. https://doi.org/10.1093/ckj/sfx149 PMid:29423210 PMCid:PMC5798130
Selim G, Stojceva-Taneva O, Zafirovska K et al. Inflammation predicts all-cause and cardiovascular mortality in hemodialysis patients. Contribution, Sec. Biol. Med. Sci. 2006; 27(1):133-44.
Li K, Yao C, Di X, et al. Smoking and Risk of All-cause Deaths in Younger and Older Adults: A Population-based Prospective Cohort Study Among Beijing Adults in China. Medicine (Baltimore). 2016; 95(3):e2438. https://doi.org/10.1097/MD.0000000000002438 PMid:26817876 PMCid:PMC4998250
Cooper R. Effect of tobacco smoking on renal function Indian J Med Res. 2006; 124:261-8.
Molander L, Hansson A, Lunell E, et al. Pharmacokinetics of nicotine in kidney failure. Clin. Pharmacol. Ther. 2000; 68:250-60. https://doi.org/10.1067/mcp.2000.109006 PMid:11014406
Govind AP, Vezina P, Green WN. Nicotine-induced upregulation of nicotinic receptors: underlying mechanisms and relevance to nicotine addiction. Biochemical pharmacology. 2009; 78(7):756-65. https://doi.org/10.1016/j.bcp.2009.06.011 PMid:19540212 PMCid:PMC2728164
Perry, Richard J, Griffiths W, Dextrase P, et al. Elevated nicotine levels in patients undergoing hemodialysis. The American Journal of Medicine. 2016; 76(2):241-6. https://doi.org/10.1016/0002-9343(84)90780-0
Sefer S, Degoricija V. About drug dialyzability. Acta Clin Croat. 2003; 42:257-67.
Longenecker JC, Coresh J, Klag MJ, et al. Validation of Comorbid Conditions on the End-Stage Renal Disease Medical Evidence Report: The CHOICE Study. J Am SocNephrol. 2000; 11(3):520-29.
Jamal A, King BA, Neff LJ, Whitmill J, Babb SD, Graffunder CM. Current Cigarette Smoking Among Adults-United States, 2005-2015. MMWR Morb Mortal Wkly Rep. 2016; 65(44):1205-11. https://doi.org/10.15585/mmwr.mm6544a2 PMid:27832052
Copyright (c) 2019 Lada Trajceska, Gjulsen Selim, Marija Zdraveska, Deska Dimitrievska, Daniela Mladenovska, Aleksandar Sikole (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All rights reserved.
