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Year : 2020  |  Volume : 20  |  Issue : 4  |  Page : 232-233

Smoking cessation as a tool for prevention of development and progression of kidney disease

Department of Nephrology, Kidney and Urology Center, Alexandria, Egypt

Date of Submission21-Jun-2020
Date of Acceptance23-Jun-2020
Date of Web Publication16-Oct-2020

Correspondence Address:
Dr. Mohamed E Elrggal
23, Mohamed Safwat Street, Roushdy, Alexandria
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jesnt.jesnt_24_20

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In the era of COVID-19, smoking has already been incriminated as an imminent risk for patients infected with SARS-COV-2. Patients with kidney disease are more susceptible to poor outcomes especially in the setting of immunosuppression and end stage kidney disease (ESKD). Hence, in our letter, we would like to throw the light on the association of smoking with kidney disease and the crucial role of smoking cessation in prevention of the development and progression of chronic kidney disease.

Keywords: chronic kidney disease prevention, chronic kidney disease progression, chronic kidney disease, smoking

How to cite this article:
Omar ME, Elrggal ME. Smoking cessation as a tool for prevention of development and progression of kidney disease. J Egypt Soc Nephrol Transplant 2020;20:232-3

How to cite this URL:
Omar ME, Elrggal ME. Smoking cessation as a tool for prevention of development and progression of kidney disease. J Egypt Soc Nephrol Transplant [serial online] 2020 [cited 2021 May 17];20:232-3. Available from: http://www.jesnt.eg.net/text.asp?2020/20/4/232/298254

In view of the current corona virus pandemic, smoking has been linked to worse outcomes and higher mortality rates in patients with COVID-19 [1],[2]. We would like to point out, from a nephrology perspective, the pivotal role of smoking cessation in primary, secondary, and tertiary prevention of kidney disease.

A tight relation has already been established between smoking and cardiovascular disease, particularly hypertension, diabetes, and chronic kidney disease (CKD) [3]. Smoking has been significantly associated with increased risk of incident type 2 diabetes mellitus [4] and hypertension [5],[6], the two most important risk factors for development of CKD. It has been associated with renal impairment and proteinuria in healthy population [7]. Regarding primordial prevention, smoking cessation improved central [8] and ambulatory blood pressure [9] in different cohorts. Smoking cessation has been linked to increased incidence of type 2 diabetes mellitus; however, this has been attributed to postcessation weight gain [10].

Concerning patients at risk for CKD, smoking has been directly associated with development of incident kidney disease [11]. It is an independent risk factor for development of diabetic nephropathy in patients with diabetes [12]. However, in terms of primary prevention, there is no evidence regarding whether smoking cessation can prevent development of CKD in at-risk patients (i.e. patients with diabetes or hypertension).

In the setting of established CKD, smoking has been associated with CKD progression [13] and increased risk for end-stage kidney disease (ESKD) [14]. Smoking cessation slowed deterioration of kidney functions and albuminuria [15],[16],[17]. It was even associated with better graft survival after kidney transplantation [18].

Finally, smoking in patients with ESKD has poor prognosis. It increases the incidence of arteriovenous fistula thrombosis [19], peripheral vascular disease, and congestive heart failure and is associated with increased cardiovascular morbidity, mortality [20], and all-cause mortality [21]. Scarce data are present regarding the benefit of smoking cessation in patients with ESKD; however, it is reasonable to assume that its benefit for the general population and patients with CKD is also applicable to patients with ESKD. In conclusion, smoking cessation fits well in the aforementioned strategies to prevent kidney disease development and progression. Smoking cessation programs should be thoroughly addressed and incorporated in the comprehensive management of patients with CKD and ESKD ([Table 1]).
Table 1 Summary of selected trials regarding the association of smoking with the development and progression of kidney diseases, and the association of smoking cessation with improvement in kidney condition

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  References Top

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Zhao Q, Meng M, Kumar R, Wu Y, Huang J, Lian N et al. The impact of COPD and smoking history on the severity of COVID-19: a systemic review and meta-analysis. J Med Virol 2020. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32293753. [cited 2020 Jun 6].  Back to cited text no. 2
Orth SR, Hallan SI. Smoking: a risk factor for progression of chronic kidney disease and for cardiovascular morbidity and mortality in renal patients-absence of evidence or evidence of absence? Clin J Am Soc Nephrol 2008; 3:226–236.  Back to cited text no. 3
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Gao K, Shi X, Wang W. The life-course impact of smoking on hypertension, myocardial infarction and respiratory diseases. Sci Rep 2017; 7:4330.  Back to cited text no. 5
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Briganti EM, Branley P, Chadban SJ, Shaw JE, McNeil JJ, Welborn TA et al. Smoking is associated with renal impairment and proteinuria in the normal population: the AusDiab kidney study. Australian diabetes, obesity and lifestyle study. Am J Kidney Dis 2002; 40:704–712.  Back to cited text no. 7
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Fox CS, Larson MG, Leip EP, Culleton B, Wilson PWF, Levy D. Predictors of new-onset kidney disease in a community-based population. JAMA 2004; 291:844.  Back to cited text no. 11
Liao D, Ma L, Liu J, Fu P. Cigarette smoking as a risk factor for diabetic nephropathy: a systematic review and meta-analysis of prospective cohort studies. Barengo NC, editor. PLoS One 2019; 14;e0210213.  Back to cited text no. 12
Phisitkul K, Hegazy K, Chuahirun T, Hudson C, Simoni J, Rajab H et al. Continued smoking exacerbates but cessation ameliorates progression of early type 2 diabetic nephropathy. Am J Med Sci 2008; 335:284–291.  Back to cited text no. 13
Ishani A, Grandits GA, Grimm RH, Svendsen KH, Collins AJ, Prineas RJ et al. Association of single measurements of dipstick proteinuria, estimated glomerular filtration rate, and hematocrit with 25-year incidence of end-stage renal disease in the multiple risk factor intervention trial. J Am Soc Nephrol 2006; 17:1444–1452.  Back to cited text no. 14
Chuahirun T, Hudson C, Seipel T, Khanna A, Simoni J, Harrist RB et al. Cigarette smoking exacerbates and its cessation ameliorates renal injury in type 2 diabetes. Am J Med Sci 2004; 327:57–67.  Back to cited text no. 15
Hieshima K, Suzuki T, Sugiyama S, Kurinami N, Yoshida A, Miyamoto F et al. Smoking cessation ameliorates microalbuminuria with reduction of blood pressure and pulse rate in patients with already diagnosed diabetes mellitus. J Clin Med Res 2018; 10:478–485.  Back to cited text no. 16
Schiffl H, Lang SM, Fischer R. Stopping smoking slows accelerated progression of renal failure in primary renal disease. J Nephrol 2002; 15:270–274.  Back to cited text no. 17
Sung RS, Althoen M, Howell TA, Ojo AO, Merion RM. Excess risk of renal allograft loss associated with cigarette smoking. Transplantation 2001; 71:1752–1757.  Back to cited text no. 18
Ozdemir FN, Akcay A, Bilgic A, Akgul A, Arat Z, Haberal M. Effects of smoking and blood eosinophil count on the development of arteriovenous fistulae thrombosis in hemodialysis patients. Transplant Proc 2005; 37:2918–2921.  Back to cited text no. 19
Foley RN, Herzog CA, Collins AJ. Smoking and cardiovascular outcomes in dialysis patients: the United States Renal Data System Wave 2 study. Kidney Int 2003; 63:1462–1467.  Back to cited text no. 20
Li NC, Thadhani RI, Reviriego-Mendoza M, Larkin JW, Maddux FW, Ofsthun NJ. Association of smoking status with mortality and hospitalization in hemodialysis patients. Am J Kidney Dis 2018; 72:673–681.  Back to cited text no. 21


  [Table 1]


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