Smoking and cardiovascular outcomes in dialysis patients: the United States Renal Data System Wave 2 study.
BACKGROUND
Smoking has received surprisingly little research attention in dialysis populations, a group at monumental cardiovascular risk.


METHODS
Medicare claims data were used to study associations between smoking and new-onset cardiovascular outcomes, and death in the prospective, inception Wave 2 cohort (N = 4024), assembled in 1996 and 1997.


RESULTS
Of the participants, 56.4% were lifetime nonsmokers, 3.6% were smokers with unknown current status, 20.0% had quit for more than 1 year, 5.8% had quit less than 1 year ago, and 14.2% were current smokers. Subjects with cardiovascular disease at baseline were more likely to be former smokers, less likely never to have smoked and less likely to be current smokers (P < 0.001). Patients were followed until December 31, 1998. When adjustment was made for baseline age, demographic variables, mode of dialysis therapy, and comorbidity, smoking status was associated with new-onset congestive heart failure (adjusted hazards ratio 1.59 comparing current to nonsmokers, P = 0.004), new-onset peripheral vascular disease (adjusted hazards ratio 1.68, P < 0.001), and mortality (adjusted hazards ratio 1.37, P < 0.001). Former smokers, in contrast, had adjusted event risks similar to lifelong nonsmokers.


CONCLUSIONS
Smoking is a major, modifiable, cardiovascular risk factor in patients starting dialysis therapy.
Foley
Robert N
RN
Cardiovascular Special Studies Center, United States Renal Data System, Minneapolis, Minnesota 55404, USA. RFoley@nephrology.org
Herzog
Charles A
CA
Collins
Allan J
AJ
D002318:Cardiovascular Diseases / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology