Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02116, USA.
Clin J Am Soc Nephrol. 2012 Nov;7(11):1827-35. doi: 10.2215/CJN.03880412. Epub 2012 Aug 23.
Smoking is common in the hemodialysis population and is associated with increased all-cause mortality and development of cardiovascular disease. Cause-specific outcomes have not yet been examined in detail. This study investigated the association of baseline smoking status with all-cause, cardiovascular, and infection-related morbidity and mortality in patients undergoing long-term hemodialysis.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Post hoc analysis of the HEMO Study in patients with available comorbidity, clinical, and nutritional data. Cox proportional hazards regression models were fit to estimate the association of smoking status with mortality. Poisson and negative binomial regression models were fit to estimate the association of smoking status with hospitalization rate.
Complete data were available for 1842 individuals (44% male, 63% black, 45% diabetic). Mean age was 58 ± 14 years. At baseline, 17% were current smokers and 32% were former smokers. After case-mix adjustment, compared with never smoking, current smoking was associated with greater infection-related mortality (hazard ratio [HR], 2.04; 95% confidence interval [CI], 1.32-3.10) and all-cause mortality (HR, 1.44; 95% CI, 1.16-1.79) and greater cardiovascular (incidence rate ratio [IRR], 1.49; 95% CI, 1.22-1.82), infection-related (IRR, 1.35; 95% CI, 1.11-1.64) and all-cause (IRR, 1.43; 95% CI, 1.24-1.65) hospitalization rates. The population attributable fraction (i.e., fraction of observed deaths that may have been avoided) was 5.3% for current smokers versus never-smokers and 2.1% for current versus former smokers.
Active smoking is prevalent in the chronic hemodialysis population and is associated with greater all-cause, cardiovascular, and infection-related morbidity and mortality.
吸烟在血液透析人群中很常见，与全因死亡率增加和心血管疾病的发展有关。尚未详细研究特定原因的结局。本研究调查了基线吸烟状况与长期血液透析患者全因、心血管和感染相关发病率和死亡率的关系。
设计、地点、参与者和测量方法：对有可用合并症、临床和营养数据的 HEMO 研究进行事后分析。使用 Cox 比例风险回归模型估计吸烟状况与死亡率的关系。使用泊松和负二项回归模型估计吸烟状况与住院率的关系。
共有 1842 人（44%为男性，63%为黑人，45%为糖尿病患者）完成了全部数据。平均年龄为 58 ± 14 岁。基线时，17%为当前吸烟者，32%为曾经吸烟者。在病例组合调整后，与从不吸烟相比，当前吸烟与更高的感染相关死亡率（风险比 [HR]，2.04；95%置信区间 [CI]，1.32-3.10）和全因死亡率（HR，1.44；95% CI，1.16-1.79）以及更高的心血管疾病（发病率比 [IRR]，1.49；95% CI，1.22-1.82）、感染相关（IRR，1.35；95% CI，1.11-1.64）和全因（IRR，1.43；95% CI，1.24-1.65）住院率相关。当前吸烟者与从不吸烟者相比，观察到的死亡人数中可能避免的比例（即归因分数）为 5.3%，当前吸烟者与曾经吸烟者相比为 2.1%。
在慢性血液透析人群中，活跃吸烟很常见，与全因、心血管和感染相关的发病率和死亡率增加有关。
