title: A randomized clinical trial to determine the effectiveness of CO-oximetry and anti-smoking brief advice in a cohort of kidney transplant patients who smoke: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  The cardiovascular risk in renal transplant patients is increased in patients who continue to smoke after transplantation. The aim of the study is to measure the effectiveness of exhaled carbon monoxide (CO) measurement plus brief advisory sessions, in comparison to brief advice, to reduce smoking exposure and smoking behavior in kidney transplant recipients who smoke. The effectiveness will be measured by: (1) abandonment of smoking, (2) increase in motivation to stop smoking, and (3) reduction in the number of cigarettes smoked per day.
  
  
  METHODS
  
  
  
  METHODS
  a randomized, controlled, open clinical trial with blinded evaluation.
  
  
  METHODS
  A Coruña Hospital (Spain), reference to renal transplantation in the period 2012-2015.
  
  
  METHODS
  renal transplant patients who smoke in the precontemplation, contemplation or preparation stages according to the Prochaska and DiClemente's Stages of Change model, and who give their consent to participate.
  
  
  METHODS
  smokers attempting to stop smoking, patients with terminal illness or mental disability that prevents them from participating.
  
  
  METHODS
  patients will be randomized to the control group (brief advisory session) or the intervention group (brief advisory session plus measuring exhaled CO). The sample target size is n = 112, with 56 patients in each group. Allowing for up to 10 % loss to follow-up, this would provide 80 % power to detect a 13 % difference in attempting to give up smoking outcomes at a two-tailed significance level of 5 %.
  
  
  METHODS
  sociodemographic characteristics, cardiovascular risk factors, treatment, rejection episodes, infections, self-reported smoking habit, drug use, level of dependence (the Fagerström test), stage of change (Prochaska and DiClemente's Stages of Change model), and motivation to giving up smoking (the Richmond test).
  
  
  RESULTS
  the effectiveness will be evaluated every 3, 6, 9 and 12 months as: pattern of tobacco use (self-reported tobacco use), smoking cessation rates, carbon monoxide (CO) levels in exhaled air measured by CO-oximetry, urinary cotinine tests, nicotine dependence (Fagerström test), motivational stages of change (Prochaska and DiClemente's stages) and motivation to stop smoking (the Richmond test).
  
  
  METHODS
  descriptive statistics and linear/logistic multiple regression models will be performed. Clinical relevance will be measured as relative risk reduction, absolute risk reduction and the number needed to treat.
  
  
  METHODS
  informed consent of the patients and Ethical Review Board was obtained (code 2011/061).
  
  
  CONCLUSIONS
  Tobacco is a modifiable risk factor that increase the risk of morbidity and mortality in kidney transplant recipients. If effectiveness of CO-oximetry is confirmed to reduce tobacco exposure, we would have an intervention that is easy to use, low cost and with great implications about cardiovascular risk prevention in these patients.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN16615772 . EudraCT number: 2015-002009-12.
authors.affiliation: Clinical Epidemiology and Biostatistics Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, Hotel de Pacientes, 7a, As Xubias, 84, 15006, A Coruña, Spain. salvador.pita.fernandez@sergas.es.
authors.forename: Salvador
authors.initials: S
authors.lastname: Pita-Fernández
authors.affiliation: Clinical Epidemiology and Biostatistics Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, Hotel de Pacientes, 7a, As Xubias, 84, 15006, A Coruña, Spain.
authors.forename: Rocío
authors.initials: R
authors.lastname: Seijo-Bestilleiro
authors.affiliation: Clinical Epidemiology and Biostatistics Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, Hotel de Pacientes, 7a, As Xubias, 84, 15006, A Coruña, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Pértega-Díaz
authors.affiliation: Nephrology Department, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Alonso-Hernández
authors.affiliation: Nephrology Department, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain.
authors.forename: Constantino
authors.initials: C
authors.lastname: Fernández-Rivera
authors.affiliation: Nephrology Department, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Cao-López
authors.affiliation: Clinical Epidemiology and Biostatistics Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, Hotel de Pacientes, 7a, As Xubias, 84, 15006, A Coruña, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Seoane-Pillado
authors.affiliation: Clinical Epidemiology and Biostatistics Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, Hotel de Pacientes, 7a, As Xubias, 84, 15006, A Coruña, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: López-Calviño
authors.affiliation: Clinical Epidemiology Research Group, Health Sciences Department, Escuela Universitaria de Enfermería y Podología, Universidade da Coruña (UDC), Campus de Ferrol, 15471, Ferrol, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: González-Martín
authors.affiliation: Nephrology Department, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Valdés-Cañedo
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D001944:Breath Tests; D002248:Carbon Monoxide / Q000378:metabolism*; D002985:Clinical Protocols; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D009042:Motivation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000378:metabolism / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D000074606:Smoking Prevention; D013030:Spain; D013997:Time Factors; D014029:Tobacco Use Disorder / Q000175:diagnosis / Q000378:metabolism / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002248:Carbon Monoxide
keywords: Carbon monoxide; Kidney transplantation; Nicotine dependence; Smoking cessation