Current and former smoking increases mortality in patients on peritoneal dialysis.
OBJECTIVE
There is limited information on the effects of smoking behaviour on mortality in patients with end-stage renal failure (ESRF). This study aimed to assess the interaction of smoking on death rate in patients with renal failure on dialysis.


METHODS
All patients (n=1293) commencing peritoneal dialysis between 1985 and 1995 for renal failure in New Zealand were prospectively followed 6 monthly until 1997 and data entered on the National database. Mortality rates were calculated from the national database and rates in patients with diabetes compared with those without diabetes and in those who did or did not smoke.


RESULTS
Follow-up data was available on all patients for a range of 20-40 months. 35% of the patients were clinically classified as having diabetic nephropathy as the cause of renal failure (11% type 1, 24% type 2). Seventeen percent of the total cohort were current smokers, 45% former smokers and 38% lifetime non smokers at dialysis commencement. These rates were similar between patients with diabetes (18% current, 51% former, 32% non-smoker) and those without diabetes (17% current, 42% former, 41% non-smoker). At survey end in 1997, 43% of the patients without diabetes had died compared with 59% of patients with type 1 diabetes (p<0.05) and 62% of patients with type 2 diabetes (p<0.05). The age-adjusted mortality of patients with a history of current or former smoking was higher than non-smokers. Those patients with diabetes and a history of smoking had even higher mortality.


CONCLUSIONS
Patients with a current or former history of smoking on peritoneal dialysis are at greatly increased risk of death. A strategy of aggressive smoking cessation efforts should be adopted for these patients at the earliest opportunity.
Braatvedt
Geoffrey D
GD
Department of Medicine, University of Auckland, Auckland, New Zealand. g.braatvedt@auckland.ac.nz
Rosie
Bronwyn
B
Bagg
Warwick
W
Collins
John
J
D017677:Age Distribution; D002318:Cardiovascular Diseases / Q000401:mortality; D015984:Causality; D015897:Comorbidity; D016001:Confidence Intervals; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality; D003928:Diabetic Nephropathies / Q000401:mortality; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D016017:Odds Ratio; D010530:Peritoneal Dialysis / Q000401:mortality*; D015995:Prevalence; D011446:Prospective Studies; D044469:Racial Groups / Q000706:statistics & numerical data; D017678:Sex Distribution; D012907:Smoking / Q000401:mortality*; D016019:Survival Analysis; D015996:Survival Rate