The Impact of Chronic Obstructive Pulmonary Disease and Smoking on Mortality and Kidney Transplantation in End-Stage Kidney DiseaseKent B.D. · Eltayeb E.E. · Woodman A. · Mutwali A. · Nguyen H.T. · Stack A.G.
aRegional Kidney Centre, Letterkenny General Hospital, Health Services Executive-West, Donegal, bPulmonary and Sleep Disorders Unit, St. Vincent’s University Hospital, Dublin, cDepartment of Medicine, University Hospital Limerick, and dGraduate Entry Medical School, University of Limerick, Limerick, Ireland
Background: Chronic obstructive pulmonary disease (COPD) and tobacco use are leading causes of morbidity and mortality. The prevalence and clinical impact of COPD on mortality and kidney transplantation among patients who begin dialysis therapy is unclear. Methods: We explored the clinical impact of COPD and continued tobacco use on overall mortality and kidney transplantation in a national cohort study of US dialysis patients. National data on all dialysis patients (n = 769,984), incident between May 1995 and December 2004 and followed until October 31, 2006, were analyzed from the United States Renal Data System. Prevalence and period trends were determined while multivariable Cox regression evaluated relative hazard ratios (RR) for death and kidney transplantation. Results: The prevalence of COPD was 7.5% overall and increased from 6.7 to 8.1% from 1995–2004. COPD correlated significantly with older age, cardiovascular conditions, cancer, malnutrition, poor functional status, and tobacco use. Adjusted mortality risks were significantly higher for patients with COPD (RR = 1.20, 95% CI 1.18–1.21), especially among current smokers (RR = 1.28, 95% CI 1.25–1.32), and varied inversely with advancing age. In contrast, the adjusted risks of kidney transplantation were significantly lower for patients with COPD (RR = 0.47, 95% CI 0.41–0.54, for smokers and RR = 0.54, 95% CI 0.50–0.58, for non-smokers) than without COPD [RR = 0.72, 95% CI 0.70–0.75, for smokers and RR = 1.00 for non-smokers (referent category)]. Conclusions: Patients with COPD who begin dialysis therapy in the US experience higher mortality and lower rates of kidney transplantation, outcomes that are far worse among current smokers.
Austin G. Stack, MD, MSc, FRCPI
Department of Medicine, Clinical Academic Liaison Building
St. Nessans Road, Graduate Entry Medical School (GEMS), University of Limerick
Tel. +353 61 234 959, E-Mail firstname.lastname@example.org
The study was performed at the Regional Kidney Centre, Department of Medicine, Letterkenny General Hospital, Donegal, and Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.
Received: April 2, 2012
Accepted: July 23, 2012
Published online: September 7, 2012
Number of Print Pages : 9
Number of Figures : 2, Number of Tables : 5, Number of References : 24
American Journal of Nephrology
Vol. 36, No. 3, Year 2012 (Cover Date: September 2012)
Journal Editor: Bakris G. (Chicago, Ill.)
ISSN: 0250-8095 (Print), eISSN: 1421-9670 (Online)
For additional information: http://www.karger.com/AJN