Trajceska Lada, Selim Gjulsen, Zdraveska Marija, Dimitrievska Deska, Mladenovska Daniela, Sikole Aleksandar
University Clinic of Nephrology, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia.
University Clinic of Pulmology and Allergology, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia.
Open Access Maced J Med Sci. 2019 Nov 11;7(21):3615-3618. doi: 10.3889/oamjms.2019.851. eCollection 2019 Nov 15.
Dialysis adequacy measured by single pool Kt/V (spKt/V) lower than 1.2 or urea reduction rate (URR) lower than 65% is associated with a significant increase in patient mortality rate. Patients' adherence to the medical treatment is crucial to achieve recommended targets for spKt/V. Smoking is a recognized factor of non-adherence.
In this study we sought to assess the association of active smoking and dialysis adequacy.
A total of 134 prevalent dialysis patients from one dialysis center were included in an observational cross-sectional study. Clinical, laboratory and dialysis data were obtained from medical charts in previous 6 months. The number of missed, on purpose interrupted or prematurely terminated dialysis sessions was obtained. Dialysis adequacy was calculated as spKt/V and URR. Patients were questioned about current active smoking status. T-test and Chi-Square test were used for comparative analysis of dialysis adequacy with regard to smoking status.
The majority of patients declared a non-smoking status (100 (75%)) and 34 (25%) were active smokers. Male gender, younger age and shorter dialysis vintage were significantly more often present in the active smokers ((9 (26%) vs 25 (73%), p = 0.028; 57.26 ± 12.59 vs 50.15 ± 14.10, p = 0.012; 118.59 ± 76.25 vs 88.82 ± 57.63, p = 0.030)), respectively. spKt/V and URR were significantly lower and Kt/V target was less frequently achieved in smokers ((1.46 ± 0.19 vs. 1.30 ± 0.021, p = 0.019; 67.14 ± 5.86 vs. 63.64 ± 8.30, p = 0.002; 14 (14%) vs. 11 (32%), p = 0.023), respectively. Shorter dialysis sessions, larger ultra filtrations and higher percentage of missed/interrupted dialysis session on patients' demand were observed in smokers (4.15 ± 0.30 vs. 4.05 ± 0.17, p = 0.019; 3.10 ± 0.78 vs. 3.54 ± 0.92, p = 0.017; 25 (0.3%) vs. 48 (1.8%), p = 0.031), respectively.
Active smokers, especially younger men, achieve lower than the recommended levels for dialysis adequacy. Non-adherence to treatment prescription in smokers is a problem to be solved. Novel studies are recommended in patients on dialysis, to further elucidate the association of dialysis adequacy with the active smoking status.
通过单池Kt/V（spKt/V）低于1.2或尿素清除率（URR）低于65%来衡量的透析充分性与患者死亡率显著增加相关。患者对医疗治疗的依从性对于达到推荐的spKt/V目标至关重要。吸烟是公认的不依从因素。
在本研究中，我们试图评估主动吸烟与透析充分性之间的关联。
一项观察性横断面研究纳入了来自一个透析中心的134例维持性透析患者。从过去6个月的病历中获取临床、实验室和透析数据。记录错过、故意中断或提前终止的透析次数。透析充分性通过spKt/V和URR计算。询问患者当前的主动吸烟状况。采用t检验和卡方检验对吸烟状况与透析充分性进行比较分析。
大多数患者声明不吸烟（100例（75%）），34例（25%）为主动吸烟者。主动吸烟者中男性、较年轻和透析时间较短的情况显著更常见（分别为9例（26%）对25例（73%），p = 0.028；57.26 ± 12.59对50.15 ± 14.10，p = 0.012；118.59 ± 76.25对88.82 ± 57.63，p = 0.030））。吸烟者的spKt/V和URR显著更低，且达到Kt/V目标的频率更低（分别为1.46 ± 0.19对1.30 ± 0.021，p = 0.019；67.14 ± 5.86对63.64 ± 8.30，p = 0.002；14例（14%）对11例（32%），p = 0.023）。吸烟者观察到透析时间更短、超滤量更大以及因患者需求错过/中断透析的比例更高（分别为4.15 ± 0.30对4.05 ± 0.17，p = 0.019；3.10 ± 0.78对3.54 ± 0.92，p = 0.017；25例（0.3%）对48例（1.8%），p = 0.031）。
主动吸烟者，尤其是年轻男性，达到的透析充分性低于推荐水平。吸烟者不遵守治疗处方是一个有待解决的问题。建议对透析患者进行新的研究，以进一步阐明透析充分性与主动吸烟状况之间的关联。
