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Association of Smoking Status With Mortality and Hospitalization in Hemodialysis Patients.
Am J Kidney Dis. 2018 11; 72(5):673-681.AJ

Abstract

RATIONALE & OBJECTIVE

The relationship between tobacco smoking and comorbid condition outcomes in hemodialysis (HD) patients is not well understood. This study examined the association of tobacco smoking status with hospitalization and mortality in HD patients.

STUDY DESIGN

Retrospective cohort study.

SETTING & PARTICIPANTS

Adult HD patients at 2,223 US dialysis centers with HD vintage of 30 days or less who completed a tobacco smoking status survey as part of standard care between April 2013 and June 2015.

PREDICTOR

Tobacco smoking category: never smoked, currently living with smoker, former smoker, moderate smoker (<1 pack per day), or heavy smoker (≥1 pack per day).

OUTCOMES

Death and hospital admissions within 2 years of the tobacco smoking survey.

ANALYTICAL APPROACH

Kaplan-Meier analysis and Cox proportional hazards regression for time to death; cumulative incidence function and Cox proportional hazards regression for time to first hospitalization; negative-binomial regression for number of hospitalizations.

RESULTS

Of 22,230 patients studied, 13% were active smokers. Mortality probabilities increased with greater exposure to smoking (17%, 22%, 23%, and 27% for never, moderate, former, and heavy smokers, respectively; P<0.001), as did incidence rates for first hospitalization (23%, 27%, 27%, and 30%, respectively; P<0.001). Compared to never smoked, heavy smokers had the highest mortality rate (HR for heavy smokers, 1.41 [95% CI, 1.18-1.69]; HR for moderate smokers, 1.39 [95% CI, 1.24-1.55]; HR for former smokers, 1.19 [95% CI, 1.11-1.28]). Living with a smoker was not associated with mortality (HR, 0.93; 95% CI, 0.72-1.22). HRs for first hospitalization followed similar patterns. The incidence rate of mortality for active smokers with diabetes was 173.7/1,000 patient-years and 103.5/1,000 patient-years for those who never smoked (incidence rate ratio, 1.68; P<0.001).

LIMITATIONS

Self-reported survey without detailed history of smoking/cessation.

CONCLUSIONS

Risks for death and hospitalization are elevated among HD patients who smoke, being highest among younger individuals and those with diabetes. Second-hand smoke was not associated with poor clinical outcomes.

Links

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Authors+Show Affiliations

Li NC
Fresenius Medical Care, North America, Waltham.
Thadhani RI
Massachusetts General Hospital, Boston, MA.
Reviriego-Mendoza M
Fresenius Medical Care, North America, Waltham.
Larkin JW
Fresenius Medical Care, North America, Waltham.
Maddux FW
Fresenius Medical Care, North America, Waltham.
Ofsthun NJ
Fresenius Medical Care, North America, Waltham. Electronic address: norma.ofsthun@fmc-na.com.

MeSH

AdultAge FactorsAgedCause of DeathCohort StudiesComorbidityFemaleHospitalizationHumansKaplan-Meier EstimateKidney Failure, ChronicMaleMiddle AgedPredictive Value of TestsPrognosisProportional Hazards ModelsRenal DialysisRetrospective StudiesRisk AssessmentSex FactorsSmokingTobacco Smoke PollutionUnited States

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29909936

Citation

Li, Nien-Chen, et al. "Association of Smoking Status With Mortality and Hospitalization in Hemodialysis Patients." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 72, no. 5, 2018, pp. 673-681.
Li NC, Thadhani RI, Reviriego-Mendoza M, et al. Association of Smoking Status With Mortality and Hospitalization in Hemodialysis Patients. Am J Kidney Dis. 2018;72(5):673-681.
Li, N. C., Thadhani, R. I., Reviriego-Mendoza, M., Larkin, J. W., Maddux, F. W., & Ofsthun, N. J. (2018). Association of Smoking Status With Mortality and Hospitalization in Hemodialysis Patients. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 72(5), 673-681. https://doi.org/10.1053/j.ajkd.2018.04.004
Li NC, et al. Association of Smoking Status With Mortality and Hospitalization in Hemodialysis Patients. Am J Kidney Dis. 2018;72(5):673-681. PubMed PMID: 29909936.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Smoking Status With Mortality and Hospitalization in Hemodialysis Patients. AU - Li,Nien-Chen, AU - Thadhani,Ravi I, AU - Reviriego-Mendoza,Marta, AU - Larkin,John W, AU - Maddux,Franklin W, AU - Ofsthun,Norma J, Y1 - 2018/06/15/ PY - 2017/04/05/received PY - 2018/04/01/accepted PY - 2018/6/19/pubmed PY - 2019/9/5/medline PY - 2018/6/19/entrez KW - Smoking KW - all-cause death KW - chronic obstructive pulmonary disease (COPD) KW - diabetes KW - dialysis KW - end-stage renal disease (ESRD) KW - hemodialysis (HD) KW - hospitalization KW - modifiable risk factor KW - mortality KW - smoking cessation KW - tobacco KW - traditional risk factor SP - 673 EP - 681 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 72 IS - 5 N2 - RATIONALE & OBJECTIVE: The relationship between tobacco smoking and comorbid condition outcomes in hemodialysis (HD) patients is not well understood. This study examined the association of tobacco smoking status with hospitalization and mortality in HD patients. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: Adult HD patients at 2,223 US dialysis centers with HD vintage of 30 days or less who completed a tobacco smoking status survey as part of standard care between April 2013 and June 2015. PREDICTOR: Tobacco smoking category: never smoked, currently living with smoker, former smoker, moderate smoker (<1 pack per day), or heavy smoker (≥1 pack per day). OUTCOMES: Death and hospital admissions within 2 years of the tobacco smoking survey. ANALYTICAL APPROACH: Kaplan-Meier analysis and Cox proportional hazards regression for time to death; cumulative incidence function and Cox proportional hazards regression for time to first hospitalization; negative-binomial regression for number of hospitalizations. RESULTS: Of 22,230 patients studied, 13% were active smokers. Mortality probabilities increased with greater exposure to smoking (17%, 22%, 23%, and 27% for never, moderate, former, and heavy smokers, respectively; P<0.001), as did incidence rates for first hospitalization (23%, 27%, 27%, and 30%, respectively; P<0.001). Compared to never smoked, heavy smokers had the highest mortality rate (HR for heavy smokers, 1.41 [95% CI, 1.18-1.69]; HR for moderate smokers, 1.39 [95% CI, 1.24-1.55]; HR for former smokers, 1.19 [95% CI, 1.11-1.28]). Living with a smoker was not associated with mortality (HR, 0.93; 95% CI, 0.72-1.22). HRs for first hospitalization followed similar patterns. The incidence rate of mortality for active smokers with diabetes was 173.7/1,000 patient-years and 103.5/1,000 patient-years for those who never smoked (incidence rate ratio, 1.68; P<0.001). LIMITATIONS: Self-reported survey without detailed history of smoking/cessation. CONCLUSIONS: Risks for death and hospitalization are elevated among HD patients who smoke, being highest among younger individuals and those with diabetes. Second-hand smoke was not associated with poor clinical outcomes. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/29909936/Association_of_Smoking_Status_With_Mortality_and_Hospitalization_in_Hemodialysis_Patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(18)30641-3 DB - PRIME DP - Unbound Medicine ER -