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Smoking and Chronic Kidney Disease

For many decades the U.S. Surgeon General has warned Americans about the ill effects from smoking. According to the Centers for Disease Control and Prevention, smoking harms nearly every organ of the body. Therefore, it is not surprising to learn that smoking also plays a role in the progression of chronic kidney disease (CKD). The first study that showed the connection between smoking and kidney disease was done in 1978. Since then many studies have supported this finding.

According to the Multiple Risk Factor Intervention Trial (MRFIT), smoking is one of the leading risk factors that can lead to end stage renal disease (ESRD).

Some of the possible ways smoking is thought to harm kidneys are by:

  • Increasing blood pressure and heart rate
  • Reducing blood flow in the kidneys
  • Increasing production of angiotensin II (a hormone produced in kidney)
  • Narrowing the blood vessels in the kidneys
  • Damaging arterioles (branches of arteries)
  • Forming arteriosclerosis (thickening and hardening) of the renal (kidney) arteries
  • Accelerating loss of kidney function

In addition to tobacco, smoking allows other toxins into the body. And according to the American Association of Kidney Patients (AAKP), studies have shown that smoking is harmful for the kidneys, and can cause kidney disease to progress and increases the risk for proteinuria (excessive amount of protein in the urine).

Diabetes, high blood pressure and chronic kidney disease

Diabetes and high blood pressure are the two leading causes of chronic kidney disease. Studies have been done on people with diabetes and/or high blood pressure to find out if smoking adds to the risk of getting chronic kidney disease. In both groups smoking increased the chances of getting renal disease. Smoking also made kidney disease occur at a faster rate. Stopping smoking was shown to be one of the most important things a person could do to help maintain kidney function.

Diabetes and end stage renal failure

For diabetics who smoke there is a higher risk of getting kidney disease, whether they have Type 1 or Type 2 diabetes. Studies have shown the kidney disease risk in diabetics is about two to three times higher than for those who don’t smoke. In diabetic smokers, there is also a 2.8 times greater risk of microalbuminuria (the presence of protein in the urine) that’s an early sign of diabetic kidney disease. For those taking insulin, smoking also advances microalbuminuria to proteinuria, which means kidneys may be failing.

For people with diabetes, stopping smoking can have a significant effect on the health of their kidneys. A study done with patients who had Type 1 diabetes and stopped smoking showed a 30% reduction in the progression of kidney disease.

High blood pressure and end stage renal failure

It has been shown in people who have high blood pressure that smoking leads to kidney disease. A study by Regalado et al showed that in 53 patients with kidney disease due to high blood pressure, after about 35 months, the single best way to predict their loss of kidney function was by their cigarette smoking. As the number of cigarettes they smoked increased, so did the rate of end stage renal disease.

Smoking raises blood pressure. For those who already have high blood pressure, smoking makes it even higher. In addition, smoking causes changes in the normal blood pressure rhythm during the daytime and nighttime. In people with high blood pressure, smoking increases the risk for microalbuminuria almost two times higher than nonsmokers.

Smokers with high blood pressure who are not taking angiotensin-converting-enzyme (ACE) inhibitors (blood pressure regulating medicines) are at about a 10 times higher risk of getting end stage renal disease than those who take the drugs.

Heart disease and smoking

Smoking causes heart disease. Kidney failure and dialysis also increase risks for heart disease. For chronic kidney disease patients who smoke, stopping may be the one most important thing they can do to slow the progression of both kidney and heart failure.

For people who have had a kidney transplant and not stopped smoking, their chances of survival decrease due to the risk of cardiovascular problems. The best way to a successful transplant outcome is to stop smoking.

Smoking even hurts healthy kidneys

According to information from the Multiple Risk Factor Intervention Trial, men in the general population, who don’t have kidney disease, are at an increased risk for getting end stage renal disease if they are smokers. The risk gets even higher for heavy smokers. Cigarette smoking has been called the most preventable risk factor for maintaining good health. Studies show that in addition to heart disease, cancer and the other diseases attributed to smoking, it has also contributed to renal failure among those who were not kidney disease patients.

Tips to stop smoking

Since the number of cigarettes smoked tend to increase the risks for end stage renal failure, cutting down may be helpful. Ideally, however, quitting would be the best option. While quitting is difficult due to nicotine addiction, cravings and temptations, there are steps to help you succeed in not smoking. Sometimes it takes a few tries to stop smoking completely, but it’s worth the effort to become smoke free.

  • Talk to your doctor about nicotine-replacement therapies like gums and patches, as well as medicines such as Zyban® to help you.
  • Give yourself a quit date and throw out all tobacco products.
  • Have a strategy for helping you overcome cravings, such as:
    • Chew gum, suck on hard candy, nibble on low-calorie snacks throughout the day or make your meals last longer.
    • Call a telephone-quit line, check websites or talk to friends and family members for support.
    • Try deep breathing or meditation until the urge passes.
  • Join a quit-smoking program.
  • Keep trying until you quit.

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