Tobacco and end stage renal disease: a multicenter, cross-sectional study in Argentinian Northern Patagonia.


BACKGROUND:Smoking and chronic kidney disease are major public health problems with common features -high prevalence and mortality, high cardiovascular risk, gender differences and high prevalence in low income people-, but the link between them is poorly recognized. Our objectives were to investigate the exposure of dialysis patients to tobacco and to know their smoking behavior. METHODS:We performed a multicenter, cross-sectional study in nine dialysis units in the Argentinian Northern Patagonia. We investigated smoker status, lifetime tobacco consumption, current tobacco use, breath carbon monoxide and % carboxyhaemoglobin. Fagerström and Richmond tests were performed for active smokers. STATISTICAL ANALYSIS:one way ANOVA and Tukey's test for post hoc test. For exploratory analysis, frequency tables through chi-square distribution and single correspondence analysis were performed. RESULTS:Six hundred thirty six patients (60.9 % males, 39.1 % females) were interviewed. Almost 70 % of them had had tobacco exposure. Excluding light smokers, the lifetime consumption was significantly different (p = 0.0052) between sexes (33.1 ± 2.4 pack/years in males and 18.2 ± 2.1 pack/years in females) The distribution of etiologies changed significantly (χ (2) p < 0.0001) with smoker status and the dose of tobacco smoking, with an increase in the diagnosis of nephrosclerosis in patients with high and very high lifetime consumption (from 16.1 % in non-smokers to 28.2 and 27 % respectively), and in passive smokers (from 16.1 to 27.3 %). The male preponderance of end-stage renal disease disappeared when only non-smokers were considered and grew with the increase in the lifetime consumption. Active smokers have small consumption, both low CO level and % COHb, low dependence and a good motivation to quit, but a high lifetime consumption. CONCLUSIONS:Exposure of dialysis patients to tobacco is high and could be related to the progression to the final stage of the renal disease. It seems that tobacco renal damage is mostly hidden in the diagnosis of nephrosclerosis. The gender difference observed in these patients could also have a nexus with the men's higher tobacco exposure. Active smokers have a low current consumption but a high lifetime tobacco dose. INTRODUCCIÓN:Tabaquismo y enfermedad renal crónica son importantes problemas de salud pública que comparten: alta prevalencia, alta morbi-mortalidad, alto riesgo cardiovascular, diferencias de género y mayor prevalencia en personas de bajos ingresos. Sin embargo, el nexo entre ellas es poco reconocido. Objetivos: mensurar la carga tabáquica de los enfermos en diálisis y conocer su patrón de consumo. MATERIAL Y MÉTODOS:Participaron nueve unidades de diálisis de la Norpatagonia Argentina. Investigamos condición de fumador, carga tabáquica y, en fumadores activos, consumo actual, tests de Richmond y Fagerström, monóxido de carbono en aire espirado y % de carboxihemoglobina. Análisis estadístico: ANOVA de una vía y test de Tukey para análisis post hoc. En el análisis exploratorio, utilizamos tablas de frecuencias a través de la distribución Ji cuadrado y análisis de correspondencia simple. RESULTADOS:Seiscientos treinta y seis pacientes (60.9 % varones, 39.1 % mujeres) fueron encuestados. Casi un 70 % de ellos había estado expuesto al tabaco. Excluyendo los fumadores leves, la carga tabáquica (CT) fue 33 ± 2.4 paquetes/año en hombres y 18.2 ± 2.1 paquetes/año en mujeres (p = 0.0052). La distribución de las etiologías de ingreso a diálisis cambió significativamente (χ2p < 0.0001) según el estado de fumador y la CT, con aumento en el diagnóstico de nefroesclerosis en fumadores pasivos (de 16.1 % en no fumadores a 27.3 %) y en pacientes con elevadas CT (de 15.2 y 16 % en CT leve y media a 28.2 y 27 % en CT alta y muy alta). La preponderancia masculina de la población desapareció en no fumadores y creció con el incremento en la CT (χ2p < 0.0001). Los fumadores activos tienen bajo consumo, bajo nivel de CO y carboxihemoglobina, baja dependencia y están bien motivados para dejar, pero tienen una elevada CT. CONCLUSIONES:La alta CT de los enfermos en diálisis podría generar o contribuir a la progresión de la enfermedad renal crónica. El daño renal por tabaco se esconde principalmente en el diagnóstico de nefroesclerosis y se relaciona con la CT. La diferencia de género de estos pacientes podría relacionarse con su exposición al tabaco. Los fumadores activos tienen bajo consumo pero elevada CT.


Tob Induc Dis


Tobacco induced diseases


Alba MM,Citarelli AN,Menni F,Agricola M,Braicovich A,De Horta E,De Rosa F,Filanino G,Gaggiotti R,Junqueras N,Martinelli S,Milan A,Morales ME,Setti S,Villalba DO




Has Abstract


2015-09-01 00:00:00














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