Smoking and Adverse Outcomes in Patients With CKD: The Study of Heart and Renal Protection (SHARP)

Natalie Staplin; Richard Haynes; William G. Herrington; Christina Reith; Alan Cass; Bengt Fellström; Lixin Jiang; Bertram L. Kasiske; Vera Krane; Adeera Levin; Robert Walker; Christoph Wanner; David C. Wheeler; Martin J. Landray; Colin Baigent; Jonathan Emberson; Colin Baigent; Martin J. Landray; Christina Reith; Jonathan Emberson; David C. Wheeler; Charles Tomson; Christoph Wanner; Vera Krane; Alan Cass; Jonathan Craig; Bruce Neal; Lixin Jiang; Lai Seong Hooi; Adeera Levin; Lawrence Agodoa; Mike Gaziano; Bertram L. Kasiske; Robert Walker; Ziad A. Massy; Bo Feldt-Rasmussen; Udom Krairittichai; Vuddidhej Ophascharoensuk; Bengt Fellström; Hallvard Holdaas; Vladimir Tesar; Andrzej Wiecek; Diederick Grobbee; Dick de Zeeuw; Carola Grönhagen-Riska; Tanaji Dasgupta; David Lewis; William G. Herrington; Marion Mafham; William Majoni; Karl Wallendszus; Richard Grimm; Terje Pedersen; Jonathan Tobert; Jane Armitage; Alex Baxter; Christopher Bray; Yiping Chen; Zhengming Chen; Michael Hill; Carol Knott; Sarah Parish; David Simpson; Peter Sleight; Alan Young; Rory Collins

doi:10.1053/j.ajkd.2016.02.052

Smoking and Adverse Outcomes in Patients With CKD: The Study of Heart and Renal Protection (SHARP)

Natalie Staplin, Richard Haynes, William G. Herrington, Christina Reith, Alan Cass, Bengt Fellström, Lixin Jiang, Bertram L. Kasiske, Vera Krane, Adeera Levin, Robert Walker, Christoph Wanner, David C. Wheeler, Martin J. Landray, Colin Baigent, Jonathan Emberson, Colin Baigent, Martin J. Landray, Christina Reith, Jonathan EmbersonDavid C. Wheeler, Charles Tomson, Christoph Wanner, Vera Krane, Alan Cass, Jonathan Craig, Bruce Neal, Lixin Jiang, Lai Seong Hooi, Adeera Levin, Lawrence Agodoa, Mike Gaziano, Bertram L. Kasiske, Robert Walker, Ziad A. Massy, Bo Feldt-Rasmussen, Udom Krairittichai, Vuddidhej Ophascharoensuk, Bengt Fellström, Hallvard Holdaas, Vladimir Tesar, Andrzej Wiecek, Diederick Grobbee, Dick de Zeeuw, Carola Grönhagen-Riska, Tanaji Dasgupta, David Lewis, William G. Herrington, Marion Mafham, William Majoni, Karl Wallendszus, Richard Grimm, Terje Pedersen, Jonathan Tobert, Jane Armitage, Alex Baxter, Christopher Bray, Yiping Chen, Zhengming Chen, Michael Hill, Carol Knott, Sarah Parish, David Simpson, Peter Sleight, Alan Young, Rory Collins

Medicine - Renal and Hypertension Division

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53 Scopus citations

Abstract

Background The absolute and relative importance of smoking to vascular and nonvascular outcomes in people with chronic kidney disease (CKD), as well its relevance to kidney disease progression, is uncertain. Study Design Observational study. Setting & Participants 9,270 participants with CKD enrolled in SHARP. Predictor Baseline smoking status (current, former, and never). Outcomes Vascular events, site-specific cancer, ESRD, rate of change in estimated glomerular filtration rate (eGFR), and cause-specific mortality. Results At baseline, 1,243 (13%) participants were current smokers (median consumption, 10 cigarettes/day); 3,272 (35%), former smokers; and 4,755 (51%), never smokers. Median follow-up was 4.9 years. Vascular event rates were 36% higher for current than never smokers (2,317 events; relative risk [RR], 1.36; 95% CI, 1.19-1.55), reflecting increases in both atherosclerotic (RR, 1.49; 95% CI, 1.26-1.76) and nonatherosclerotic (RR, 1.25; 95% CI, 1.05-1.50) events. Cancer was 37% higher among current smokers (632 events; RR, 1.37; 95% CI, 1.07-1.76), with the biggest RRs for lung (RR, 9.31; 95% CI, 4.37-19.83) and upper aerodigestive tract (RR, 4.87; 95% CI, 2.10-11.32) cancers. For 6,245 patients not receiving dialysis at baseline, ESRD incidence did not differ significantly between current and never smokers (2,141 events; RR, 1.02; 95% CI, 0.89-1.17), nor did estimated rate of change in eGFR (current smokers, −1.77 ± 0.14 [SE]; never smokers, −1.70 ± 0.07 mL/min/1.73 m² per year). All-cause mortality was 48% higher among current smokers (2,257 events; RR, 1.48; 95% CI, 1.30-1.70), with significant increases in vascular (RR, 1.35; 95% CI, 1.07-1.69) and nonvascular (RR, 1.60; 95% CI, 1.34-1.91) causes of death, especially cancer (RR, 2.32; 95% CI, 1.58-3.40) and respiratory (RR, 2.25; 95% CI, 1.51-3.35) mortality. Limitations Smoking status not assessed during follow-up. Conclusions In this study of patients with CKD, smoking significantly increased the risks for vascular and nonvascular morbidity and mortality, but was not associated with kidney disease progression. The associations with vascular and neoplastic disease are in keeping with those observed in the general population and are likely modifiable by cessation.

Original language	English (US)
Pages (from-to)	371-380
Number of pages	10
Journal	American Journal of Kidney Diseases
Volume	68
Issue number	3
DOIs	https://doi.org/10.1053/j.ajkd.2016.02.052
State	Published - Sep 1 2016

Bibliographical note

Funding Information:
Support: SHARP was funded by Merck/Schering-Plough Pharmaceuticals (North Wales, PA), with additional support from the Australian National Health Medical Research Council, the British Heart Foundation , and the UK Medical Research Council . SHARP was initiated, conducted, and interpreted independently of the principal study funder (Merck & Co and Schering Plough Corp, which merged in 2009). The Clinical Trial Service Unit and Epidemiological Studies Unit, which is part of the University of Oxford, has a staff policy of not accepting honoraria or consultancy fees.

Publisher Copyright:
© 2016 The Authors

Keywords

Cigarette smoking
Study of Heart and Renal Protection (SHARP)
cancer
cause-specific mortality
chronic kidney disease (CKD)
disease progression
end-stage renal disease (ESRD)
estimated glomerular filtration rate (eGFR)
risk factor
tobacco
vascular events
vascular morbidity

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1053/j.ajkd.2016.02.052

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Staplin, N., Haynes, R., Herrington, W. G., Reith, C., Cass, A., Fellström, B., Jiang, L., Kasiske, B. L., Krane, V., Levin, A., Walker, R., Wanner, C., Wheeler, D. C., Landray, M. J., Baigent, C., Emberson, J., Baigent, C., Landray, M. J., Reith, C., ... Collins, R. (2016). Smoking and Adverse Outcomes in Patients With CKD: The Study of Heart and Renal Protection (SHARP). American Journal of Kidney Diseases, 68(3), 371-380. https://doi.org/10.1053/j.ajkd.2016.02.052

Staplin, N, Haynes, R, Herrington, WG, Reith, C, Cass, A, Fellström, B, Jiang, L, Kasiske, BL, Krane, V, Levin, A, Walker, R, Wanner, C, Wheeler, DC, Landray, MJ, Baigent, C, Emberson, J, Baigent, C, Landray, MJ, Reith, C, Emberson, J, Wheeler, DC, Tomson, C, Wanner, C, Krane, V, Cass, A, Craig, J, Neal, B, Jiang, L, Hooi, LS, Levin, A, Agodoa, L, Gaziano, M, Kasiske, BL, Walker, R, Massy, ZA, Feldt-Rasmussen, B, Krairittichai, U, Ophascharoensuk, V, Fellström, B, Holdaas, H, Tesar, V, Wiecek, A, Grobbee, D, de Zeeuw, D, Grönhagen-Riska, C, Dasgupta, T, Lewis, D, Herrington, WG, Mafham, M, Majoni, W, Wallendszus, K, Grimm, R, Pedersen, T, Tobert, J, Armitage, J, Baxter, A, Bray, C, Chen, Y, Chen, Z, Hill, M, Knott, C, Parish, S, Simpson, D, Sleight, P, Young, A & Collins, R 2016, 'Smoking and Adverse Outcomes in Patients With CKD: The Study of Heart and Renal Protection (SHARP)', American Journal of Kidney Diseases, vol. 68, no. 3, pp. 371-380. https://doi.org/10.1053/j.ajkd.2016.02.052

@article{8ce5f4818adb4340b44c4e07a767f9f6,

title = "Smoking and Adverse Outcomes in Patients With CKD: The Study of Heart and Renal Protection (SHARP)",

abstract = "Background The absolute and relative importance of smoking to vascular and nonvascular outcomes in people with chronic kidney disease (CKD), as well its relevance to kidney disease progression, is uncertain. Study Design Observational study. Setting & Participants 9,270 participants with CKD enrolled in SHARP. Predictor Baseline smoking status (current, former, and never). Outcomes Vascular events, site-specific cancer, ESRD, rate of change in estimated glomerular filtration rate (eGFR), and cause-specific mortality. Results At baseline, 1,243 (13%) participants were current smokers (median consumption, 10 cigarettes/day); 3,272 (35%), former smokers; and 4,755 (51%), never smokers. Median follow-up was 4.9 years. Vascular event rates were 36% higher for current than never smokers (2,317 events; relative risk [RR], 1.36; 95% CI, 1.19-1.55), reflecting increases in both atherosclerotic (RR, 1.49; 95% CI, 1.26-1.76) and nonatherosclerotic (RR, 1.25; 95% CI, 1.05-1.50) events. Cancer was 37% higher among current smokers (632 events; RR, 1.37; 95% CI, 1.07-1.76), with the biggest RRs for lung (RR, 9.31; 95% CI, 4.37-19.83) and upper aerodigestive tract (RR, 4.87; 95% CI, 2.10-11.32) cancers. For 6,245 patients not receiving dialysis at baseline, ESRD incidence did not differ significantly between current and never smokers (2,141 events; RR, 1.02; 95% CI, 0.89-1.17), nor did estimated rate of change in eGFR (current smokers, −1.77 ± 0.14 [SE]; never smokers, −1.70 ± 0.07 mL/min/1.73 m2 per year). All-cause mortality was 48% higher among current smokers (2,257 events; RR, 1.48; 95% CI, 1.30-1.70), with significant increases in vascular (RR, 1.35; 95% CI, 1.07-1.69) and nonvascular (RR, 1.60; 95% CI, 1.34-1.91) causes of death, especially cancer (RR, 2.32; 95% CI, 1.58-3.40) and respiratory (RR, 2.25; 95% CI, 1.51-3.35) mortality. Limitations Smoking status not assessed during follow-up. Conclusions In this study of patients with CKD, smoking significantly increased the risks for vascular and nonvascular morbidity and mortality, but was not associated with kidney disease progression. The associations with vascular and neoplastic disease are in keeping with those observed in the general population and are likely modifiable by cessation.",

keywords = "Cigarette smoking, Study of Heart and Renal Protection (SHARP), cancer, cause-specific mortality, chronic kidney disease (CKD), disease progression, end-stage renal disease (ESRD), estimated glomerular filtration rate (eGFR), risk factor, tobacco, vascular events, vascular morbidity",

author = "Natalie Staplin and Richard Haynes and Herrington, {William G.} and Christina Reith and Alan Cass and Bengt Fellstr{\"o}m and Lixin Jiang and Kasiske, {Bertram L.} and Vera Krane and Adeera Levin and Robert Walker and Christoph Wanner and Wheeler, {David C.} and Landray, {Martin J.} and Colin Baigent and Jonathan Emberson and Colin Baigent and Landray, {Martin J.} and Christina Reith and Jonathan Emberson and Wheeler, {David C.} and Charles Tomson and Christoph Wanner and Vera Krane and Alan Cass and Jonathan Craig and Bruce Neal and Lixin Jiang and Hooi, {Lai Seong} and Adeera Levin and Lawrence Agodoa and Mike Gaziano and Kasiske, {Bertram L.} and Robert Walker and Massy, {Ziad A.} and Bo Feldt-Rasmussen and Udom Krairittichai and Vuddidhej Ophascharoensuk and Bengt Fellstr{\"o}m and Hallvard Holdaas and Vladimir Tesar and Andrzej Wiecek and Diederick Grobbee and {de Zeeuw}, Dick and Carola Gr{\"o}nhagen-Riska and Tanaji Dasgupta and David Lewis and Herrington, {William G.} and Marion Mafham and William Majoni and Karl Wallendszus and Richard Grimm and Terje Pedersen and Jonathan Tobert and Jane Armitage and Alex Baxter and Christopher Bray and Yiping Chen and Zhengming Chen and Michael Hill and Carol Knott and Sarah Parish and David Simpson and Peter Sleight and Alan Young and Rory Collins",

note = "Funding Information: Support: SHARP was funded by Merck/Schering-Plough Pharmaceuticals (North Wales, PA), with additional support from the Australian National Health Medical Research Council, the British Heart Foundation , and the UK Medical Research Council . SHARP was initiated, conducted, and interpreted independently of the principal study funder (Merck & Co and Schering Plough Corp, which merged in 2009). The Clinical Trial Service Unit and Epidemiological Studies Unit, which is part of the University of Oxford, has a staff policy of not accepting honoraria or consultancy fees. Publisher Copyright: {\textcopyright} 2016 The Authors",

year = "2016",

month = sep,

day = "1",

doi = "10.1053/j.ajkd.2016.02.052",

language = "English (US)",

volume = "68",

pages = "371--380",

journal = "American Journal of Kidney Diseases",

issn = "0272-6386",

publisher = "W.B. Saunders Ltd",

number = "3",

}

TY - JOUR

T1 - Smoking and Adverse Outcomes in Patients With CKD

T2 - The Study of Heart and Renal Protection (SHARP)

AU - Staplin, Natalie

AU - Haynes, Richard

AU - Herrington, William G.

AU - Reith, Christina

AU - Cass, Alan

AU - Fellström, Bengt

AU - Jiang, Lixin

AU - Kasiske, Bertram L.

AU - Krane, Vera

AU - Levin, Adeera

AU - Walker, Robert

AU - Wanner, Christoph

AU - Wheeler, David C.

AU - Landray, Martin J.

AU - Baigent, Colin

AU - Emberson, Jonathan

AU - Baigent, Colin

AU - Landray, Martin J.

AU - Reith, Christina

AU - Emberson, Jonathan

AU - Wheeler, David C.

AU - Tomson, Charles

AU - Wanner, Christoph

AU - Krane, Vera

AU - Cass, Alan

AU - Craig, Jonathan

AU - Neal, Bruce

AU - Jiang, Lixin

AU - Hooi, Lai Seong

AU - Levin, Adeera

AU - Agodoa, Lawrence

AU - Gaziano, Mike

AU - Kasiske, Bertram L.

AU - Walker, Robert

AU - Massy, Ziad A.

AU - Feldt-Rasmussen, Bo

AU - Krairittichai, Udom

AU - Ophascharoensuk, Vuddidhej

AU - Fellström, Bengt

AU - Holdaas, Hallvard

AU - Tesar, Vladimir

AU - Wiecek, Andrzej

AU - Grobbee, Diederick

AU - de Zeeuw, Dick

AU - Grönhagen-Riska, Carola

AU - Dasgupta, Tanaji

AU - Lewis, David

AU - Herrington, William G.

AU - Mafham, Marion

AU - Majoni, William

AU - Wallendszus, Karl

AU - Grimm, Richard

AU - Pedersen, Terje

AU - Tobert, Jonathan

AU - Armitage, Jane

AU - Baxter, Alex

AU - Bray, Christopher

AU - Chen, Yiping

AU - Chen, Zhengming

AU - Hill, Michael

AU - Knott, Carol

AU - Parish, Sarah

AU - Simpson, David

AU - Sleight, Peter

AU - Young, Alan

AU - Collins, Rory

N1 - Funding Information: Support: SHARP was funded by Merck/Schering-Plough Pharmaceuticals (North Wales, PA), with additional support from the Australian National Health Medical Research Council, the British Heart Foundation , and the UK Medical Research Council . SHARP was initiated, conducted, and interpreted independently of the principal study funder (Merck & Co and Schering Plough Corp, which merged in 2009). The Clinical Trial Service Unit and Epidemiological Studies Unit, which is part of the University of Oxford, has a staff policy of not accepting honoraria or consultancy fees. Publisher Copyright: © 2016 The Authors

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Background The absolute and relative importance of smoking to vascular and nonvascular outcomes in people with chronic kidney disease (CKD), as well its relevance to kidney disease progression, is uncertain. Study Design Observational study. Setting & Participants 9,270 participants with CKD enrolled in SHARP. Predictor Baseline smoking status (current, former, and never). Outcomes Vascular events, site-specific cancer, ESRD, rate of change in estimated glomerular filtration rate (eGFR), and cause-specific mortality. Results At baseline, 1,243 (13%) participants were current smokers (median consumption, 10 cigarettes/day); 3,272 (35%), former smokers; and 4,755 (51%), never smokers. Median follow-up was 4.9 years. Vascular event rates were 36% higher for current than never smokers (2,317 events; relative risk [RR], 1.36; 95% CI, 1.19-1.55), reflecting increases in both atherosclerotic (RR, 1.49; 95% CI, 1.26-1.76) and nonatherosclerotic (RR, 1.25; 95% CI, 1.05-1.50) events. Cancer was 37% higher among current smokers (632 events; RR, 1.37; 95% CI, 1.07-1.76), with the biggest RRs for lung (RR, 9.31; 95% CI, 4.37-19.83) and upper aerodigestive tract (RR, 4.87; 95% CI, 2.10-11.32) cancers. For 6,245 patients not receiving dialysis at baseline, ESRD incidence did not differ significantly between current and never smokers (2,141 events; RR, 1.02; 95% CI, 0.89-1.17), nor did estimated rate of change in eGFR (current smokers, −1.77 ± 0.14 [SE]; never smokers, −1.70 ± 0.07 mL/min/1.73 m2 per year). All-cause mortality was 48% higher among current smokers (2,257 events; RR, 1.48; 95% CI, 1.30-1.70), with significant increases in vascular (RR, 1.35; 95% CI, 1.07-1.69) and nonvascular (RR, 1.60; 95% CI, 1.34-1.91) causes of death, especially cancer (RR, 2.32; 95% CI, 1.58-3.40) and respiratory (RR, 2.25; 95% CI, 1.51-3.35) mortality. Limitations Smoking status not assessed during follow-up. Conclusions In this study of patients with CKD, smoking significantly increased the risks for vascular and nonvascular morbidity and mortality, but was not associated with kidney disease progression. The associations with vascular and neoplastic disease are in keeping with those observed in the general population and are likely modifiable by cessation.

AB - Background The absolute and relative importance of smoking to vascular and nonvascular outcomes in people with chronic kidney disease (CKD), as well its relevance to kidney disease progression, is uncertain. Study Design Observational study. Setting & Participants 9,270 participants with CKD enrolled in SHARP. Predictor Baseline smoking status (current, former, and never). Outcomes Vascular events, site-specific cancer, ESRD, rate of change in estimated glomerular filtration rate (eGFR), and cause-specific mortality. Results At baseline, 1,243 (13%) participants were current smokers (median consumption, 10 cigarettes/day); 3,272 (35%), former smokers; and 4,755 (51%), never smokers. Median follow-up was 4.9 years. Vascular event rates were 36% higher for current than never smokers (2,317 events; relative risk [RR], 1.36; 95% CI, 1.19-1.55), reflecting increases in both atherosclerotic (RR, 1.49; 95% CI, 1.26-1.76) and nonatherosclerotic (RR, 1.25; 95% CI, 1.05-1.50) events. Cancer was 37% higher among current smokers (632 events; RR, 1.37; 95% CI, 1.07-1.76), with the biggest RRs for lung (RR, 9.31; 95% CI, 4.37-19.83) and upper aerodigestive tract (RR, 4.87; 95% CI, 2.10-11.32) cancers. For 6,245 patients not receiving dialysis at baseline, ESRD incidence did not differ significantly between current and never smokers (2,141 events; RR, 1.02; 95% CI, 0.89-1.17), nor did estimated rate of change in eGFR (current smokers, −1.77 ± 0.14 [SE]; never smokers, −1.70 ± 0.07 mL/min/1.73 m2 per year). All-cause mortality was 48% higher among current smokers (2,257 events; RR, 1.48; 95% CI, 1.30-1.70), with significant increases in vascular (RR, 1.35; 95% CI, 1.07-1.69) and nonvascular (RR, 1.60; 95% CI, 1.34-1.91) causes of death, especially cancer (RR, 2.32; 95% CI, 1.58-3.40) and respiratory (RR, 2.25; 95% CI, 1.51-3.35) mortality. Limitations Smoking status not assessed during follow-up. Conclusions In this study of patients with CKD, smoking significantly increased the risks for vascular and nonvascular morbidity and mortality, but was not associated with kidney disease progression. The associations with vascular and neoplastic disease are in keeping with those observed in the general population and are likely modifiable by cessation.

KW - Cigarette smoking

KW - Study of Heart and Renal Protection (SHARP)

KW - cancer

KW - cause-specific mortality

KW - chronic kidney disease (CKD)

KW - disease progression

KW - end-stage renal disease (ESRD)

KW - estimated glomerular filtration rate (eGFR)

KW - risk factor

KW - tobacco

KW - vascular events

KW - vascular morbidity

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UR - http://www.scopus.com/inward/citedby.url?scp=84964626148&partnerID=8YFLogxK

U2 - 10.1053/j.ajkd.2016.02.052

DO - 10.1053/j.ajkd.2016.02.052

M3 - Article

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AN - SCOPUS:84964626148

SN - 0272-6386

VL - 68

SP - 371

EP - 380

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

IS - 3

ER -

Smoking and Adverse Outcomes in Patients With CKD: The Study of Heart and Renal Protection (SHARP)

Abstract

Bibliographical note

Keywords

UN SDGs

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