Smoking, Vascular Events, and ESRD in Patients With CKD

Smoking is the leading modifiable cause of morbidity and mortality in the general population. In the United States, about 40 million adults currently smoke, for an estimated prevalence of 16.8% in 2014. Cigarette smoking is considered responsible for about 480,000 deaths per year in the United States, with millions more experiencing smoking-related diseases. The annual direct cost to the US health care system associated with smoking amounts to more than $170 billion, with.60% of this enormous spending paid by government-funded programs such as Medicare and Medicaid. The evidence linking cigarette smoking with cardiovascular disease, cancer, and death in the general population is overwhelming. The adverse effects of smoking have also been observed in individuals with chronic kidney disease (CKD). The prevalence of current smoking reported in CKD populations varies between 10% and 15%, with up to 56% of individuals with mild to moderate CKD reporting exposure to more than 100 cigarettes during their lifetime. With more than 26 million Americans living with CKD, interventions to reduce exposure to cigarette smoking are of great public health importance. In this issue ofAJKD, Staplin et al report the results of a large longitudinal study evaluating the association between smoking habits and adverse outcomes, namely vascular events, cancer, and end-stage renal disease (ESRD), among 9,270 adults with CKD, including more than 6,000 individuals who were not receiving dialysis at the time of enrollment in The Study of Heart and Renal Protection (SHARP). At study entry, 13% of participants self-reported current median consumption of 10 cigarettes per day, 35% were former smokers, and 51% reported never smoking. Participants were followed up for nearly 5 years, during which 25% experienced at least 1 vascular event, 7% had cancer diagnosed, 34% developed ESRD, and 24%died. The authors found a significantly elevated risk for atherosclerotic and nonatherosclerotic vascular events, in particular among participants with a history of cardiovascular disease, with relative risks