Smoking and cardiovascular outcomes in dialysis patients: the United States Renal Data System Wave 2 study

Kidney Int. 2003 Apr;63(4):1462-7. doi: 10.1046/j.1523-1755.2003.00860.x.


Background: Smoking has received surprisingly little research attention in dialysis populations, a group at monumental cardiovascular risk.

Methods: Medicare claims data were used to study associations between smoking and new-onset cardiovascular outcomes, and death in the prospective, inception Wave 2 cohort (N = 4024), assembled in 1996 and 1997.

Results: Of the participants, 56.4% were lifetime nonsmokers, 3.6% were smokers with unknown current status, 20.0% had quit for more than 1 year, 5.8% had quit less than 1 year ago, and 14.2% were current smokers. Subjects with cardiovascular disease at baseline were more likely to be former smokers, less likely never to have smoked and less likely to be current smokers (P < 0.001). Patients were followed until December 31, 1998. When adjustment was made for baseline age, demographic variables, mode of dialysis therapy, and comorbidity, smoking status was associated with new-onset congestive heart failure (adjusted hazards ratio 1.59 comparing current to nonsmokers, P = 0.004), new-onset peripheral vascular disease (adjusted hazards ratio 1.68, P < 0.001), and mortality (adjusted hazards ratio 1.37, P < 0.001). Former smokers, in contrast, had adjusted event risks similar to lifelong nonsmokers.

Conclusion: Smoking is a major, modifiable, cardiovascular risk factor in patients starting dialysis therapy.

MeSH terms

  • Cardiovascular Diseases / epidemiology*
  • Female
  • Humans
  • Incidence
  • Kidney Failure, Chronic / epidemiology*
  • Male
  • Middle Aged
  • Peritoneal Dialysis / statistics & numerical data*
  • Renal Dialysis / statistics & numerical data*
  • Risk Factors
  • Risk Reduction Behavior
  • Smoking / epidemiology*
  • United States / epidemiology