Dialysis patients who smoke are more likely to die and less likely to receive a kidney transplant than non-smokers, a new study suggests.

In a population-based cohort study of 1,220,000 US dialysis patients, investigators at the University of Limerick in Ireland led by Austin G. Stack, MD, found that patients with pre-existing coronary disease who continue to smoke had a significant 14% increased risk of death compared with non-smokers without cardiovascular disease (reference group) after adjusting for age, gender, race, and other potential confounders. Smokers who had a prior stroke or had peripheral artery disease (PAD) had significantly higher risks of death by 22% compared with those without these conditions, Dr Stack’s group reported online in BMC Nephrology.

Among patients without coronary disease, prior stroke, or PAD, smokers continued to experience elevated mortality risks of 9%, 8%, and 7%, respectively, compared with non-smokers.

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Quite strikingly, the adverse effect of smoking on mortality was significantly greater for younger patients than older patients, according to the investigators. For example, for patients younger than 50 years, smokers with coronary disease experienced a 76% higher mortality risk compared with non-smokers in the fully adjusted model. By comparison, the mortality risk for smokers aged 77 years or older with coronary disease was 30% higher.

Smokers also experienced significantly lower rates of kidney transplantation, and the negative impact of smoking was greatest for patients with pre-existing cardiovascular conditions.

The likelihood of kidney transplantation among smokers with coronary disease, prior stroke, or PAD was significantly lower by 39%, 50%, and 43%, respectively, compared with non-smokers who did not have these conditions.

Among patients without coronary disease, prior stroke, or PAD, smokers continued to experience lower risks of kidney transplantation, which were 26%, 25%, and 26% lower than non-smokers respectively.

The new study shows, for the first time, that continued smoking by dialysis patients significantly reduces their chance of a kidney transplant and increases their mortality risk, according to Dr Stack.

“We believe strongly that greater focus and attention be given to the identification of patients who are smokers at all stages of CKD, including those that develop kidney failure and require dialysis,” Dr Stack told Renal & Urology News. “All patients, young and old, should be regularly counseled on the benefits of quitting and offered smoking cessation strategies. Given the frequency of contact between dialysis patients and their healthcare providers, there are multiple opportunities at these encounters to establish a dialogue with patients and develop personalized smoking cessation strategies.”