title: Smoking in dialysis patients: a systematic review and meta-analysis of mortality and cardiovascular morbidity.
abstract: BACKGROUND
  Cigarette smoking is associated with increased cardiovascular morbidity and mortality in the general population, but the effect of smoking on these outcomes in the dialysis population is less well studied.
  
  
  METHODS
  Systematic review and meta-analysis of cohort studies.
  
  
  METHODS
  Adults treated with long-term hemodialysis or peritoneal dialysis. SELECTION CRITERIA FOR INCLUDED STUDIES: Cohort studies of unselected dialysis patients reporting the association between smoking status and cardiovascular morbidity and/or mortality.
  
  
  METHODS
  Smoking status (determined using patient report).
  
  
  RESULTS
  (1) All-cause or cardiovascular mortality; (2) incident cardiovascular events.
  
  
  RESULTS
  We identified 34 studies that fulfilled all inclusion criteria. Of these, 26 studies provided data for smoking and mortality and 10 (n = 6,538) were included in a meta-analysis. The pooled HR for all-cause mortality in smokers compared with nonsmokers was 1.65 (95% CI, 1.26-2.14; P < 0.001). 11 studies provided data for smoking and incident cardiovascular events; 5 (pooled n = 845) were included in a meta-analysis. The pooled HR for composite cardiovascular events in smokers compared with nonsmokers was 1.01 (95% CI, 0.98-1.05; P = 0.4).
  
  
  CONCLUSIONS
  Data for these meta-analyses were heterogeneous. Few individual studies assessed smoking as the primary variable of interest.
  
  
  CONCLUSIONS
  Active smoking is associated with a significant increase in all-cause mortality in dialysis patients, although there was no corresponding increased risk of cardiovascular events.
authors.affiliation: Division of Nephrology, University of Rochester Medical Center, NY, USA. scott_liebman@urmc.rochester.edu
authors.forename: Scott E
authors.initials: SE
authors.lastname: Liebman
authors.forename: Steven P
authors.initials: SP
authors.lastname: Lamontagne
authors.forename: Li-Shan
authors.initials: LS
authors.lastname: Huang
authors.forename: Susan
authors.initials: S
authors.lastname: Messing
authors.forename: David A
authors.initials: DA
authors.lastname: Bushinsky
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D006435:Renal Dialysis / Q000401:mortality*; D012907:Smoking / Q000009:adverse effects / Q000401:mortality*