Active Smoking is Associated with Lower Dialysis Adequacy in Prevalent Dialysis Patients

Active smoking and dialysis adequacy

  • Lada Trajceska University Clinic of Nephrology, Skopje, Macedonia
  • Gjulsen Selim University Clinic of Nephrology, Skopje, Macedonia
  • Marija Zdraveska University Clinic of Pulmology and Allergology, Skopje, Macedonia
  • Deska Dimitrievska University Clinic of Pulmology and Allergology, Skopje, Macedonia
  • Daniela Mladenovska University Clinic of Nephrology, Skopje, Macedonia
  • Aleksandar Sikole University Clinic for Nephrology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
Keywords: End-stage kidney disease, Dialysis adequacy, Smoking, Compliance


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.


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Author Biography

Aleksandar Sikole, University Clinic for Nephrology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje

Aleksandar Sikole graduated at the Medical Faculty-University "Sv. Kiril i Metodij" of Skopje, with MD degree in 1980. Specialized internal medicine in and subspecialized nephrology. Completed PhD thesis in 1994, entitled: “The effect of erythropoietin therapy on the heart and bone marrow of end-stage renal disease patients on maintenance haemodialysisâ€. Since 2006 is Professor of Medicine at the Chair of Internal Medicine. He spent six months on postgraduate medical research at the Department of Nephrology of the University of Leiden , The Netherlands. In 2003 he had three months sabbatical at Laiko hospital, Athens, Greece. He was chief of hemodialysis unit at the Clinic of Nephrology and at present Director of the Clinic. Published and/or presented over 150 papers in national and international journals, books, and national and international congresses, symposia, proceedings etc. Involved in the organisation of several national and international congresses and symposia. Has conducted several clinical prospective multicentre studies in patients with chronic kidney disease. Was invited lecturer at several national and a few international meetings. Member of several medical and nephrological societies.


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How to Cite
Trajceska L, Selim G, Zdraveska M, Dimitrievska D, Mladenovska D, Sikole A. Active Smoking is Associated with Lower Dialysis Adequacy in Prevalent Dialysis Patients: Active smoking and dialysis adequacy . Open Access Maced J Med Sci [Internet]. 2019Nov.11 [cited 2021Jan.27];7(21):3615-8. Available from:
B - Clinical Sciences