Analysis of Smoking in Chronic Kidney Dialytic Patients and Cardiovascular Events

Introduction: Chronic kidney disease (CKD) is an important public health issue with an estimated worldwide prevalence of 8 to 16%. It is responsible for high morbidity and mortality rates, but many of the risk factors for its development and progression are said to be modifiable. Systemic arterial hypertension (SAH) and diabetes mellitus (DM) are the main etiologies. Recent studies have demonstrated the role of smoking, also. The delayed perception that smoking impairs renal function as hypertension is due to the silent response of the kidney to vascular lesions. The risk of death in general and from cardiovascular events in chronic kidney smokers is twice as high as in the rest of the population.

Objective: To verify the prevalence of hypertension, smoking, DM and cardiovascular events in patients with CKD in a large hospital in São Paulo.

Methodology: This is a multicenter, clinical epidemiological, observational, analytical and quantitative cross-sectional study conducted between January and May 2019 with 134 patients on hemodialysis and peritoneal dialysis. Data were collected through medical records and the application of a questionnaire.

Results: SAH was the most prevalent etiology followed by DM: respectively 49.7% and 11.3% alone and in 12% of the sample concomitantly. After: undetermined causes (12.8%), Nephrotic Syndrome (6%), HIV (4.5%), Glomerulonephritis (2.3%) and Lupus (1.5%). The prevalence of smokers and former smokers were 6.7% and 39.6%; 53.7% said they had never smoked. Only 23.1% of the sample never came into contact with tobacco, actively or passively; 34% had cardiovascular events and the most prevalent were CAD (24.6%) and stroke (12.7%). Active and/or passive smoking was present in the previous history of 76% of these patients.

Discussion: The onset’s age of dialysis was 49.7±14.6 years in opposition to the 2015 literature of 60 years: there is an earlier dialytic dependence of the population due to high rates of chronic disease diagnoses in younger individuals by today’s modern lifestyle.

Conclusion: SAH and DM were the most prevalent etiologies of CKD in the sample, and tobacco was remarkable in the previous history of these patients, showing a positive association between active and/or passive smoking and the occurrence of cardiovascular events: public awareness policies. The harm of tobacco, including to the kidney, is necessary, in addition to encouraging the suspension of its use in CKD.

Keywords:Smoking; Chronic kidney disease; Cardiovascular events; Dialysis; Cardiovascular risk factors