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Updated: Mar 22, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Smoking and Adverse Outcomes in Patients With CKD: The Study of Heart and Renal Protection (SHARP)
Natalie Staplin1, Richard Haynes1, William G Herrington1
1Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
Insights
Smoking significantly increases vascular and nonvascular risks in chronic kidney disease (CKD) patients, leading to higher morbidity and mortality. However, smoking does not appear to accelerate kidney disease progression.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Oncology
- Epidemiology
Background:
- The impact of smoking on vascular and nonvascular outcomes in chronic kidney disease (CKD) patients remains unclear.
- Its specific relevance to the progression of kidney disease requires further investigation.
Purpose of the Study:
- To investigate the association between smoking status and various health outcomes in individuals with CKD.
- To determine if smoking influences the progression of kidney disease.
Main Methods:
- An observational study involving 9,270 participants with CKD from the SHARP study.
- Baseline smoking status (current, former, never) was assessed.
- Outcomes included vascular events, cancer, end-stage renal disease (ESRD), estimated glomerular filtration rate (eGFR) change, and mortality.
Main Results:
- Current smokers (13%) had a 36% higher risk of vascular events and a 37% higher risk of cancer compared to never smokers.
- Lung and upper aerodigestive tract cancers showed the most significant increases in risk.
- Smoking was not associated with a higher incidence of ESRD or a faster decline in eGFR.
- All-cause mortality was 48% higher in current smokers, with increased risks from vascular, cancer, and respiratory causes.
Conclusions:
- Smoking is a significant risk factor for vascular and nonvascular morbidity and mortality in CKD patients.
- Smoking cessation may be a modifiable factor to reduce these risks.
- The study did not find an association between smoking and kidney disease progression.
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±0.07mL/min/1.73m(2) 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.
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