Summary of the article -Smoking causes diffuse endothelial injury, causing vascular diseases all over the body and can rapidly progress the diabetic nephropathy and IgA nephropathy as well as causing arterial hylainosis and chronic sclerosing nephropathy in the kidney graft. -Regarding the renal allograft, Smoking may acutely reduce the eGFR by up to 10-15% and may lead to rapid progression of proteinuria, diabetic nephropathy, as well as reduced renal blood flow. -Ways that aid in quitting smoking include counseling and group sessions hand in hand with pharmacological agents entailing nicotinic cholinergic receptor partial agonist and Bupropion.
This is a review article of level 5 evidence.
Wee Leng Gan
2 years ago
Smoking was associated with lowering patient and graft survival. Cotinine is considered a promising biomarker of smoking exposure. However, the use of cotinine also has its limitations as Cotinine level is a reflection of smoking over the past few days, and this may be misleading if the patient is smoking occasionally. The second limitation lies in its inability to differentiate between never-smoking and former-smoking. Thus, the combination of cotinine measurement and self-reporting of smoking exposure will be the most reliable approach in evaluating renal transplant population. Donor smoking and recipient former smoking proved to have a negative impact on survival. Transplant community should pay more attention to donor and recipient smoking cessation programs.
level 5 evidence
Nazik Mahmoud
2 years ago
This study discuss the effect of smoking on patient with ckd , kidney transplant recipient and donor, it had a bad effect of kidney disease like diabetic nephropathy,IgA and APKD it increase their progression also it decrease the graft survival as well.
it is a level 5 evidence .
we can help the renal transplant recipient to stop smoking by counselling about the risk of losing the graft and help them by increasing the physical activity.
the effect of the smoking on the donor as it decrease the GFR in the donate kidney and made them liable to cardiovascular disease
Amna Khalifa
2 years ago
Briefly summarise this article INTRODUCTION : Smoking is a challenging health care problem; it has a well-established correlation with many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death. Cigarette smoking assumes to be responsible for atherosclerosis, endothelial dysfunction, progression of vascular disease progression of proteinuria, as it contains large amounts of free radicals.
This makes smoking a significant renal risk factor, with considerable consequences on health care budget. The effect of smoking is aggravated in renal transplant recipients due to
· Effect of immune suppression medications on carcinogenesis
· Effect of chronic kidney disease itself on cardiovascular risk and mortality Effects of smoking on the kidney
smoking may lead to progression of many intrinsic renal diseases (e.g., diabetic nephropathy, IgA nephropathy and autosomal dominant polycystic kidney disease).
Ritz et al. studied the effect of smoking on healthy normotensive volunteers.
· They reported a significant increase in arginine vasopressin levels and serum epinephrine
· increase in renal vascular resistance by 11%
· decrease in the glomerular filtration rate (GFR) by 15%.
· They assumed these effects are secondary to nicotine itself as these findings were reproduced by using nicotine containing gum.
Pinto-Sietsma et al. They documented
· the presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment in this screening.
· These findings were less obvious or absent in former smokers Recipient smoking and transplantation outcome
Smoking associated with fatal outcomes, these complications are aggravated in solid organ transplant recipients.
Smoking is a well-known risk factor for cardiovascular disease.
It is associated with malignancy which is the 2nd cause of death post-transplantation
The effect of smoking on renal transplant recipients was investigated in several studies , one of them revealed that, current smokers had an increase in the severity of vascular intimal fibrous thickening.
While, most of these studies have revealed a clear benefit of smoking cessation on graft survival.
but the effect on patient survival is less clear. Effect of smoking habit of kidney donor on the outcome of transplantation :
Studies reported the following:
1. It may be logic that the recipient smoking will affect his own survival, but surprisingly, even the donor smoking will affect the recipient survival years after transplantation.
2. The effect of donor smoking on graft survival was statistically insignificant . Unlike the recipient smoking which proved to be significant .
3. the recipients of smoking donors had lower calculated GFR Smoking biomarker and renal transplantation
A proper estimation of the risks associated with tobacco use depends on accurate measurement of exposure, which may be difficult in certain population such as pregnant women and parents of young children, where smoking considered socially unaccepted.
Some patients may not recall the number of cigarettes accurately (digit bias). and finally the tobacco dose differs between individuals due to the difference between cigarettes as well as the difference in inhaling habits (passive smoking.
All these factors made the development of a valid and accurate biomarker for tobacco smoking of ultimate importance.
Cotinine is the major metabolite of nicotine. It has a relatively constant level due its long half-life (16 h vs 2-3 h for nicotine), which can be measured in plasma or urine.
For these reasons, cotinine is considered a promising biomarker of smoking exposure
Hellemons et al reported using the above biomarker that active smoking had a negative impact on patient and graft survival, while former smokers had increased the risk of mortality but not graft failure.
The use of cotinine also has its limitations.
· Cotinine level is a reflection of smoking over the past few days, and this may be misleading if the patient is smoking occasionally .
· The second limitation lies in its inability to differentiate between never-smoking and former-smoking. Conclusion
· Smoking remains a major modifiable health care challenge; it is the leading cause of variable morbidities and mortality.
· The use of smoking biomarkers proved to be reliable in evaluation and quantification of smoking exposure in the transplant population.
· Donor smoking and recipient former smoking proved to have a negative impact on survival.
· Transplant community should pay more attention to donor and recipient smoking cessation programs.
What is the level of evidence provided by this article?
5
How do you help renal transplant patients to stop smoking?
Psychological support, advising to join programs to quit smoking , medications which helps to stop smoking .
What is the effect of smoking on kidney donors?
Increasing risk of anesthesia , risk of hypertension, risk of ckd, risk of chest infection. and most importantly risk of cardiovascular disease.
death rate among kidney donors who were smokers significantly higher than non smoker and they were found to have higher serum creatinine at end of 1 year as compared to nonsmokers.
Fatima AlTaher
2 years ago
1) Summary
Smoking is a very common worldwide prevalent risk factor for several CV, pulmonary and malignant conditions. Smoking also has its hazardous impact on normal kidney that become more severe on kidney graft due chronic immunosuppressive status and the metabolic derangement caused by immunosuppressive drugs, where poorer recipient and graft survival were encountered in smokers compared to nonsmoker recipients and even graft from smoker donor has lower survival rate compared with nonsmoker donor.
CV effects of smoking include exaggerated atherosclerosis, endothelial dysfunction, increase vascular resistance, hormonal disturbance as increase secretion of epinephrine and arginine vasopressin.
On the kidney, smoking produce dose dependent albuminuria and decrease in GFR.
On kidney recipients, smoking leads to poor patient survival as it increases the risk of CV diseases and malignancy that are the leading causes for death among kidney recipients.
Smoking causes variable, severe pathological changes in kidney graft that shortens the graft survival as chronic glomerular sclerosis and arterial hyalinosis.
Studies evaluating the impact of smoking on kidney recipients and graft survival had several limitations as most studies depend on self-reported questionnaire as till now no well-known marker to reflect severity of smoking status is available. A new biomarker, cotinine, the end metabolite of nicotine has been currently investigated but it also has its limitation as it reflects smoking status during the last few days so not accurate if the patient was an occasional smoker or stopped smoking recently.
Active smoking was associated with increased graft loss and patient death while former smoking was associated with increased recipient death but not graft loss.
2) level of evidence :5
3) How to help the patient to stop smoking
a) Counselling the smokers regarding hazardous effects of smoking.
b) Motivation and phycological support.
c) Pharmacological interventions to help nicotine withdrawal via electronic cigarettes, nicotine replacement programs with Bupropion and nicotinic cholinergic receptor agonist.
4) Effect of smoking on kidney donor:
as smoking is associated with increased CV morbidity and mortality risk, premature atherosclerosis which in turn increase the risk of CKD after kidney donation.
Alyaa Ali
2 years ago
Effects of smoking on the kidney
1.Smoking plays a role in the progression of many intrinsic renal disease as DN, IgA nephropathy and APKD
2.Smoking leads to increase renal vascular resistance and decrease in GFR, these effects are secondary to nicotine itself.
3.There is a dose dependent association between smoking and development of both microalbuminuria and renal impairment.
Effect of recipient smoking and transplant outcomes
1.Cardiovascular disease is leading cause of death in renal recipients.The development of denovo cardiovascular insult in the first year post-transplant was associated with smoking , pre-existing cardiovascular disease,HTN, older age and duration of dialysis.
2.Malignancy is the second leading of death after transplantation there is a clear relation between smoking and malignancy.
3.Increase in the severity of vascular intimal fibrous thickening on renal biopsy of kidney recipients.
Effect of smoking habit of kidney donor on the outcome of transplantation
1.Donar smoking will affect the recipient survival years after transplantation.
2.The recipients of smoking donors had lower calculated GFR.
Smoking biomarker and renal transplantation
Evaluation of renal transplant population should be done by combination of cotinine measurement and self reporting of smoking exposure.
Question 2
level of evidence 5
Question 3
How do you help renal transplant patients to stop smoking?
Through smoking cessation programs
first approach is non-pharmaceutical, using motivational and cognitive interviewing of the patient (counselling).
A pharmaceutical approach must be adapted the patient medical history and expectations.
Nicotine replacement therapy , Bupropion, Nicotinic cholinergic receptor partial agonist and electronic cigarette.
Question 4
Effect of smoking in kidney donor
Donors with a smoking history have increased risk for development of CKD after kidney donation.
.
Last edited 2 years ago by Alyaa Ali
Hinda Hassan
2 years ago
Effects of smoking on the kidney
Smoking has a role in the progression of many intrinsic renal diseases (e.g., diabetic nephropathy, IgA nephropathy and autosomal dominant polycystic kidney disease)
Smoking can affect healthy kidneys in form of increase in arginine vasopressin levels ( and serum epinephrine with an increase in renal vascular resistance and a decrease in the glomerular filtration rate. Smoking was associated with the development of albuminuria and abnormal kidney functions in non-diabetic population in a dose-dependent association manner.
Recipient smoking and transplantation outcome
1. cardiovascular disease. : de novo cardiovascular insult in the first year post-transplant
2. malignancy
3. renal biopsy : increase in the severity of vascular intimal fibrous thickening , chronic sclerosing nephropathy and arteriolar hyalinosis
Effect of smoking habit of kidney donor on the outcome of transplantation
donor smoking will affect the recipient survival years after transplantation and graft survival.
Smoking biomarker and renal transplantation
cotinine is considered a promising biomarker of smoking exposure
level of evidence is 5
Nicotine addiction is complex and the rate of successful prolonged abstinence without any intervention is dramatically low. Different therapeutic approaches for smoking patients are available and have proven their efficacy. They should be offered whenever possible Even if they no longer smoke, donors with a smoking history require close observation due to increased risk of CKD development after kidney donation.
Yoon, Y. E., Lee, H. H., Na, J. C., Huh, K. H., Kim, M. S., Kim, S. I., … Han, W. K. (2018). Impact of Cigarette Smoking on Living Kidney Donors. Transplantation Proceedings, 50(4), 1029–1033. doi:10.1016/j.transproceed.2018.02.050
10.1016/j.transproceed.2018.02.050
Asmaa Khudhur
2 years ago
Smoking in Renal Transplantation; Facts Beyond Myth
INTRODUCTION
Smoking is a challenging health care problem; it has a well-established correlation with many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death.Cigarette smoking assumes to have a role in atherosclerosis, endothelial dysfunction, progression of vascular disease progression of proteinuria, as it contains large amounts of free radicals.This makes smoking a significant renal risk factor, with considerable consequences on health care budget.
The effect of smoking is aggravated in renal trans- plant recipients due to the effect of immune suppression medications on carcinogenesis, in addition to the effect of chronic kidney disease itself on cardiovascular risk and mortality.
EffECTs Of smOkINg ON ThE kIDNEy
many studies confirmed the role played by smoking in the progression of many intrinsic renal diseases (e.g., diabetic nephropathy, IgA nephropathy and autosomal dominant polycystic kidney disease)
Ritz et al, reported a significant increase in arginine vasopressin levels and serum epinephrine .There was an increase in renal vascular resistance by 11% and a decrease in the glomerular filtration rate (GFR) by 15%.
Pinto-Sietsma et al, documented the presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment in this screening. These findings were less obvious or absent in former smokers.
RECIpIENT smOkINg aND TRaNsplaNTaTION OUTCOmE
Smoking is a well-known risk factor for cardiovascular disease. Ponticelli et al,have addressed the role of cardiovascular disease as the leading cause of death in renal transplant recipient. The development of de novo cardiovascular insult in the first year post-transplant was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and duration of dialysis.
The second leading cause of death post-trans- plantation was malignancywith a clear association between smoking and increased risk for certain types of malignancy.
Zitt et al, had a unique approach by studying the relation between smoking and renal biopsy findings .Current smokers had an increase in the severity of vascular intimal fibrous thickening .While the degree of chronic sclerosing nephropathy and arteriolar hyalinosis were associated with the duration of time post-transplantation.
Most of these studies have revealed a clear benefit of smoking cessation on graft survival, but the effect on patient survival is less clear possibly reflecting the permanent atherosclerotic effect on the vascular system.
EffECT Of smOkINg habIT Of
kIDNEy DONOR ON ThE OUTCOmE Of
TRaNsplaNTaTION
Although it makes sense that the recipient’s smoking will have an impact on his own longevity, it’s astonishing to learn that recipient survival even years after transplantation will be impacted by donor smoking.
According to Lin et al., a donor’s smoking behavior has a minor but statistically significant impact on recipient and graft survival.
smOkINg bIOmaRkER aND RENal TRaNsplaNTaTIO.
The main metabolite of nicotine is cotinine. Due to its lengthy half-life (16 h vs. 2-3 h for nicotine), which may be detected in plasma or urine, it has a reasonably steady level. Cotinine is regarded as a possible biomarker of smoking exposure because of these factors.
Level 3
Counseling the recipients to quit smoking at least 4 weeks before transplantation by helping them through special programs that explain the harm of smoking on kidney and heart as well.
Mohammed Sobair
2 years ago
INTRODUCTION
Smoking has a well-established correlation with many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death.
Cigarette smoking assumes to have a role in atherosclerosis, endothelial dysfunction, progression of vascular disease progression of proteinuria, as it contains large amounts of free radicals.
effect of smoking is aggravated in renal transplant recipients due to the effect of immune suppression medications on carcinogenesis, in addition to the effect of chronic kidney disease itself on cardiovascular risk and mortality. Effect of smoking on the kidney:
There was an increase in renal vascular resistance by 11% and a decrease in the glomerular filtration rate (GFR) by 15%.
Also its documented the presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment in this screening. These findings were less obvious or absent in former smokers. The effect of recipient smoking and transplant outcome:
The development of de novo cardiovascular insult in the first year post-transplant was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and duration of dialysis.
The second leading cause of death post-transplantation was malignancy with a clear association between smoking and increased risk for certain types of malignancy. Effect of smoking habit of kidney donor on the outcome of transplantation:
smoking habit of the donor has mild, yet statistically significant effect on recipient survival and graft survival . Smoking biomarker and renal transplantation Smoking exposure :
Cotinine is the major metabolite of nicotine. It has a relatively constant level due its long half-life (16 h vs 2-3 h for nicotine), which can be measured in plasma or urine. For these reasons, cotinine is considered a promising biomarker of smoking exposure.
How do you help renal transplant patients to stop smoking?
should pay more attention to donor and recipient smoking cession program ,education
and drugs therapy for those who failed education and smoking quit session.
What is the effect of smoking on kidney donors
smoking donors had lower calculated GFR (37.0 mL/min per 1.73 m2 .
Dalia Ali
2 years ago
INTRODUCTION
Smoking is a challenging health care problem; it has a well-established correlation with many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death
. Cigarette smoking
assumes to have a role in atherosclerosis, endothelial dysfunction, progression of vascular disease progression of proteinuria, as it contains large amounts of free radicals
This makes smoking a significant renal risk
factor, with considerable consequences on health care budget
Effects of smoking on the kidney
The hazards of smoking were investigated thoroughly in association with cardiovascular disease, lung disease and oncogenesis. However, the effect of smoking on healthy kidney and progression of primary kidney diseases did not attract great attention
Recipient smoking and transplantation outcome
Smoking is strongly correlated to some of the potentially fatal outcomes, and there is some evidence that these complications are aggravated in solid organ transplant recipients
Smoking is a well-known risk factor for cardiovascular disease. Ponticelli et al[7]
have addressed the role of
cardiovascular disease as the leading cause of death in renal transplant recipient. The development of de novo cardiovascular insult in the first year post-transplant was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and duration of dialysis
Effect of smoking habit of kidney donor on the outcome of transplantation
It may be logic that the recipient smoking will affect his own survival, but surprisingly, even the donor smoking will affect the recipient survival years after transplantation
. Lin et Al have analysed data from the United Network for Organ Sharing from 1994 to 1999, and they declared that smoking habit of the donor has mild, yet statistically significant effect on recipient survival (HR = 1.06, P < 0.05), and graft survival (HR = 1.05, P < 0.05).
Smoking biomarker and renal transplantation
Smoking exposure and analysis of dose of smoking depends on self-reporting in most of the studies
which we strongly believe it lacks accuracy. A proper estimation of the risks associated with tobacco use depends on accurate measurement of exposure, which may be difficult in certain population such as pregnant women and parents of young children, where smoking considered socially unaccepted
The use of cotinine also has its limitations. Cotinine
level is a reflection of smoking over the past few days, and this may be misleading if the patient is smoking occasionally (like in weekends) or if the patient was smoking less due to a period of illness. The second limitation lies in its inability to differentiate between never-smoking and former-smoking
Differentiating
never-smoking from former-smoking is clinically relevant as former-smoking was proved to be associated with increasing risk of recipient mortality
We believe that the combination of cotinine measurement and self-reporting of smoking exposure will be the most reliable approach in evaluating renal transplant population.
Conclusion
Smoking remains a major modifiable health care challenge; it is the leading cause of variable morbidities and mortality. The use of smoking biomarkers proved to be reliable in evaluation and quantification of smoking exposure in the transplant population. Donor smoking and recipient former smoking proved to have a negative impact on survival. Transplant community should pay more attention to donor and recipient smoking cessation programs.
Level 5
Councilling with our candidate about the risk of smoking on heart and kidneys
Ahmed Omran
2 years ago
Smoking is a risk factor of CVD, pulmonary diseases, malignancy and mortality.
It is associated with increased exposure to nicotine, AVP, adrenaline, reno-vascular resistance, urine ACR and GFR reduction.
Smoking has negative impact on progressive course of diabetic kidney disease, IgA nephropathy and polycystic kidneys.
Increased malignancy with smoking leads to reduced graft and patient survival.
Serum cotinine levels can be used to evaluate potential smoker transplant recipients.
Level:
Level 5, Narrative review.
Smoking cessation:
Counselling, abstain smoking 4 weeks pre -Tx, using smoking cessation programs, pharmacological approach is very helpful.
Smoking potential donors could have reduced GFR, patient survival, increased peri-operative complications, risk of malignancy ,wound infections and cardio-vascular disease.
Nasrin Esfandiar
2 years ago
Summarization of the article: The correlation between renal outcomes and smoking hasn’t really been studied, even though arteriosclerotic diseases might bring up some risk. A smoking recipient would have the risk of cardiovascular diseases. However, the study by Zitt et al showed increasing severity of fibrous thickening of the vascular intima and in arteriolar hyalinosis and the degree of chronic sclerosing nephropathy had a correlation with duration of post-transplantation time, through biopsy of kidney transplant recipients Studies have shown the existence of a lower glomerular filtration rate and a lower graft survival in smoker donors. Self-report studies asses the smoking burden, however, their accuracy is very questionable concerning specific groups, in addition to the presence of various tobacco burdens in different types of cigarettes, requires an accurate and valid smoking biomarker. The level of evidence provided by this article is 5, since it is a review. Helping renal transplant patients to stop smoking: Through the interdisciplinary program, focused on quitting cigarettes, they would have multidisciplinary support with various specialties for: cardiology, pulmonology, etc. The effect of smoking on kidney donors: There was a correlation between the existence of microalbuminuria and its collateral kidney damage, and the dose of smoking in the study done by Pinto Sietsma et al. In other studies, they showed the decrease in the glomerular filtration rate (GFR) by 15% and an increase in renal vascular resistance by 11% (studies such as that done by Ritz et al,).
Abdullah Raoof
2 years ago
Q1 Briefly summarise this article?
Smoking in Renal Transplantation; Facts Beyond Myth
Abstract
There are evidence correlating tobacco use with pathological changes in the normal kidneys. This effect is obvious on the renal allograft may be due to the chronic immune suppression status and the metabolic effect of the drugs. Smoking associated with lower patient and graft survival. Smoking cessation proved to improve graft survival and to a lesser extent recipient survival. Even receiving a renal transplant from a smoker donor increases the risk of death for the recipient and carries apoorer graft survival compared to non-smoking donors. INTRODUCTION:
Cigarette smoking assumes to have a role in atherosclerosis, endothelial dysfunction, progression of vascular disease progression of proteinuria, as it contains large amounts of free radicals.
The effect of smoking is aggravated in renal transplant recipients due to the effect of immune suppression medications on carcinogenesis, in addition to the effect of chronic kidney disease itself on cardiovascular
risk and mortality.
Effects of smokin g on the kidney:
studies proved the role of smoking in the progression of many renal diseases (diabetic nephropathy, IgA nephropathy and autosomal dominant polycystic kidney disease).In one study through the effect of smoking there is an increase in renal vascular resistance by 11% and a decrease in the glomerular filtration rate (GFR) by 15%. these effects most probably due to effect of nicotine itself as these findings were reproduced by using nicotine containing gum.
Pinto-Sietsma et al, report the presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment .
Recipient smoking and transplantation outcome :
Smoking is a well-known risk factor for cardiovascular disease. Ponticelli et al report the role of cardiovascular disease as the leading cause of death in renal transplant recipient. The development of cardiovascular insult in the first year post-transplant was associated with smoking and other factors .
The second leading cause of death post-trans plantation was malignancy with a clear association between smoking and increased risk of malignancy. It worth to mentioning that Zitt et al report that Current smokers had an increase in the severity of vascular intimal fibrous thickening . Most of these studies have revealed a clear benefit of smoking cessation on graft survival.
Effect of smoking habit of kidney on the outcome of transplantation:
It is logic that the recipient smoking will affect his own survival, but, even the donor smoking will affect the recipient survival years after transplantation. Lin et al, report that smoking of the donor has mild, yet statistically significant effect on recipient survival and graft survival . Underwood et al, report that the effect of donor smoking on graft survival was statistically insignificant, unlike the recipient smoking which proved to be significant. the recipient survival was negatively correlated to donor smoking , and recipient smoking . Heldt et al report that the recipients of smoking donors had lower calculated GFR. Smoking biomarker And renal transplantation:
Cotinine is the major metabolite of nicotine. It has a relatively constant level due its long half-life , which can be measured in plasma or urine. For these reasons, cotinine is considered an exposure promising biomarker of smoking. Conclusion :
Ø Smoking remains a major modifiable health care challenge;
Ø it is the leading cause of variable morbidities and mortality.
Ø The use of smoking biomarkers proved to be reliable in evaluation and quantification of smoking exposure in the transplant population.
Ø Donor smoking and recipient former smoking proved to have a negative impact on survival.
Ø Transplant community should pay more attention to donor and recipient smoking cessation programs
Q2 – What is the level of evidence provided by this article?
Level 5
Q3- How do you help renal transplant patients to stop smoking?
He may need multidisciplinary team work and to put patient in smoking cessation program.
Q4- What is the effect of smoking on kidney donors?
Like its effect on any individual it is increase the incidence of cardiovascular , pulmonary disease – COPD , malignancy.
Manal Malik
2 years ago
Summary of Smoking in Renal Transplantation; Facts Beyond Myth The aim of this work is to review the current evidence to improve our understanding of this article’s topic. This will help to guide better-designed studies in the future.
Introduction
The effect of smoking aggraded in renal Transplant recipients due to the effect of immune suppression medication is carcinogenesis and effect on CKD, CVS, and mortality Effect of smoking on the kidney
The effect of smoking a healthy kidney and release progression of some renal diseases e.g diabetic nephropathy, IgA nephropathy, and autosomal dominant polycystic kidney disease.
Presence of a dose-dependent association between smoking and the development of both microalbumin and renal impairment in this severing this case study.
Recipient smoking and Transplantation outline
Development of de Novo CVS insult in the first year
Post-transplant was associated with pre-existing CVS disease older age pre-transplant HTN smoking and duration of dialysis
Second leading cause of death the post-transplant was malignancy and there is an association between smoking and increased risk for a certain type of malignancy
Effect of the smoking habit of kidney donor on the out came of transplantation
Recipient and donor smoking effect recipient survival after transplantation
The study evaluated 100 lives donors who smoked and at a mean follow-up of 25 months, this found-that recipients of smoking donors had lower calculated GFR
Smoking Biomarker and Renal Transplantation:
The need for an accurate biomarker for tobacco smoking is crucial because the same patient can not recall the number of cigarettes accurately (2) dose is different based on habit and type of cigarettes.
Continue is the metabolism of nicotine has a long half-life 16 versus 2-3 hours for nicotine
the aim was to investigate the relationship of self-reporting and cotinine exposure in the transplant population and to evaluate the use of cotinine as an alternative for self-report.
smoking increased the risk of mortality but not graft failure.
limitation of cotinine level is a reflection of smoking over the past few days and this may be misleading. if the patient smokes occasionally.
so the combination of cotinine measurement and self-reporting of smoking exposure will be the most reliable in the renal population.
Conclusion:
Smoking is cause variable morbidities and mortality
use of smoking biomarkers provide to be reliable in the evaluation of smoking exposure in transplant populations.
Donor and recipient smoking has a negative impact a survival.
level 5
how to help postrenal transplant patients to quit smoking?
patient should be counselled about the risk of smoking for CVS and the risk will be more than the general population in the presence of CKD also the immunosuppression put him at more risk and referral to a smoking session clinic
the risk of smoking in the kidney increases the microalbuminuria, the progression of CKD(decrease e GFR) and increase renal vascular resistance.
CARLOS TADEU LEONIDIO
2 years ago
Briefly summarise this article
The relationship between smoking and renal outcomes has been little studied at this time, even with the risk that arteriosclerotic diseases can bring. For the recipient who smokes, cardiovascular diseases are the big problem, but the study by Zitt et al was able to show, through biopsy of kidney transplant recipients, an increase in the severity of fibrous thickening of the vascular intima and in the degree of chronic sclerosing nephropathy and arteriolar hyalinosis were associated with duration of post-transplantation time. For the donor who smokes, studies have already shown the existence of a lower graft survival and a lower glomerular filtration rate. Assessment of smoking burden relies on self-report studies, but the accuracy of these is highly questionable for certain populations , as well as the presence of different tobacco burdens in different types of cigarettes, drives the need for a valid and accurate biomarker for smoking .
What is the level of evidence provided by this article?
Level 05 – because is resume review
How do you help renal transplant patients to stop smoking?
In our center, he receives multidisciplinary support through the interdisciplinary program (various specialties: cardiology, pulmonology, etc.) specifically for smoking cessation.
What is the effect of smoking on kidney donors?
The study by Pinto Sietsma et al., noticed a relationship between the dose of smoking and the existence of microalbuminuria and with it kidney damage. In other studies, such as that by Ritz et al, it was shown that there is an increase in renal vascular resistance by 11% and a decrease in the glomerular filtration rate (GFR) by 15%
Hamdy Hegazy
2 years ago
Briefly summarize this article
Smoking is associated with high risk of CVD, pulmonary disease, malignancy and mortality. Smoking leads to increased exposure to nicotine, increased AVP, increased adrenaline, increased reno-vascular resistance, increased urine ACR and reduced GFR. Smoking is linked to progressive course of diabetic kidney disease, IgA nephropathy and polycystic kidneys. Malignancy is increased with smoking that leads to reduced graft and patient survival. Serum cotinine levels can be used to evaluate transplant recipients.
What is the level of evidence provided by this article?
Level 5, Narrative review.
How do you help renal transplant patients to stop smoking?
Counselling, stop smoking 4 weeks before Tx, smoking cessation programs, pharmacological therapies are very helpful.
What is the effect of smoking on kidney donors?
Can lead to reduced GFR, reduced patient survival, increased peri-operative complications, wound infections, increased risk of malignancy and cardio-vascular disease.
Ahmed Abd El Razek
2 years ago
INTRODUCTION
Smoking is known to cause serious cardiovascular, pulmonary diseases, malignancy and death. Smoking accelerates atherosclerosis, induces endothelial dysfunction, progression of vascular disease, progression of proteinuria via production of large amounts of free radicals.
The effect of immunosuppressive therapy enhances carcinogenesis in renal transplant
recipients besides the cardiovascular risk and mortality manifested by the previous state of chronic renal disease are additive factors aggravated by smoking.
Hazards of smoking
Several studies highlighted the fact that smoking enhances the progression of various intrinsic renal diseases like diabetic nephropathy, IgA nephropathy and autosomal dominant polycystic kidney disease.
Ritz et al assessed the effect of smoking on healthy normotensive individuals, they found an increase in renal vascular resistance by 11% and a decline in the glomerular filtration rate (GFR) by 15%.other study conducted by Pinto-Sietsma et al to determine the effect of smoking on the development of albuminuria and renal impairment in non-diabetic population revealed the presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment.
Recipient smoking and transplantation outcome
Hazards of smoking are known to be aggravated in solid organ transplant recipients. According to Ponticelli et al the leading cause of death in renal transplant recipients is cardiovascular disease. Cardiovascular events can occur denovo post-transplant due to pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and long duration of dialytic support.
Malignancy is the second leading cause of death post-transplantation which is also linked to smoking and increased susceptibility to certain types of malignancy.
Zitt et al had a characteristic approach by assessing the relation between smoking and renal biopsy findings of renal transplant recipients. They determined that there is an increased severity of vascular intimal fibrous thickening in current smokers, also the longer duration of smoking post transplantation, the higher the degree of chronic sclerosing nephropathy and arteriolar hyalinosis.
Other studies came out with the presence of a clear benefit of smoking cessation on graft survival.
Effect of smoking habit of kidney donor on the outcome of transplantation
It was astonishing that even the donor smoking will affect the recipient survival years after transplantation. The recipient survival was negatively correlated to donor smoking according to Underwood et al. The recipients of smoking donors had lower calculated GFR as declared by Heldt et al.
Smoking biomarker and renal transplantation
It is believed that self-reporting about smoking is known to be inaccurate urging the need to establish a valid accurate biomarker for tobacco smoking. Cotinine is the major metabolite of nicotine with a relatively constant level as it has a long half-life. It can be monitored in plasma or urine. Thus, cotinine is regarded as a promising biomarker of smoking exposure.
Cotinine measurement can be misleading if the patient is smoking occasionally as weekends or during period of illness. Another limitation is the inability to discriminate between never-smoking and former-smoking.
Active smoking had a negative impact on both patient and graft survival, while former smokers had high risk of mortality only without risk of graft failure.
Conclusion: Transplant communities have to pay attention to both donor and recipient smoking cessation programs.
Level of evidence is 5.
To help renal transplant recipients to quit smoking , psychosocial support is offered ,healthy lifestyle including healthy diet and exercises is advised, patient counselling about smoking hazards on both survival and graft should be discussed and finally enrollment in smoking cessation program. Effect of smoking on kidney donors:
They require close observation due to increased risk of CKD development after kidney donation. Smoking cessation strategies should be implemented in kidney donors.
Tobacco smoking in 40 year donors and more is associated with post-operative development of CKD after 24 months.
Abhijit Patil
2 years ago
Briefly summarize this article
Increase in renal vascular resistance by 11%
Decrease in the glomerular filtration rate (GFR) by 15%.
Recipient smoking and transplantation outcome
a clear benefit of smoking cessation is seen on graft survival
the recipient survival is negatively correlated to donor smoking and recipient smoking
Cotinine is the major metabolite of nicotine. It has a relatively constant level due its long half-life (16 h vs 2-3 h for nicotine), which can be measured in plasma or urine. For these reasons, cotinine is considered promising biomarker of smoking exposure
What is the level of evidence provided by this article?
Level 5 narrative review
How do you help renal transplant patients to stop smoking?
By showing and educating about the ill effects of smoking
The patient should be referred to psychiatrist and enrolled in de-addiction program
Nicotine gums or patches may initially help in de-addiction
What is the effect of smoking on kidney donors?
Smoking is a known risk factor for hypertension, cardiovascular morbidity and malignancy
These all factors have ill effects on donor life
saja Mohammed
2 years ago
Briefly summarize this article
Introduction
The smoking effect has been well documented on cardiovascular and pulmonary diseases including malignancies and death, but we have limited data about its effect on the renal system and in particular renal transplantation population however, based on the available retrospective small studies still smoking can have a harmful outcome on the renal system due to the effect of the free radicals in addition to the augmented effect due to low immunity and immunosuppression medications, CKD with further increased risk of atherosclerosis and CVD and malignancies, and affect the graft and patient survival even transplantation from smoker donors found to have an impact on the transplant outcome compared to nonsmoker donors anew promising biomarkers cotinine have more objective indication about the smoking effect and can be a goal for future prospective studies to improve our knowledge about this important preventive risk factors
This study focused on reviewing the previous work on the smoking consequence and addressing the limitation of previous studies and help for future prospective research that aid and guide us for a better understanding of this hazardous defensive risk factor. Effect of smoking on the kidneys
Smoking can worsen the progress of many primary kidney diseases like Diabetic nephropathy, IgA nephropathy, and APCKD.
The nicotine effect of smoking can lead to an increase the arginine level and epinephrin based on small studies and increased renal vascular resistance BY 11% also smoking can lead to a reduction in GFR by 15% compared to nonsmokers and in one cross-sectional study, they found that smoking associated with dose-related increase risk of microalbuminuria and deterioration of renal function in nondiabetic healthy populations. Effect of smoking on kidneys transplant recipients Most of the studies are retrospective and have small sample size however they concluded the deleterious effect of smoking on graft survival and to less extent on patient survival due to co-existing cardiovascular risk and atherosclerosis also one interesting histological finding in one report confirm the harmful effect of smoking on the graft survival by the increased risk of vascular change including arteriolar fibrous intimal thickening which can contribute to chronic allograft nephropathy and graft loss (zitt et al ).and in one study reported in addition to worsening graft and patient survival also smoking the increased risk of rejection( Nogueira et al[18) Effect of the smoking habit of kidneys transplant donors on the recipient outcome
Diverse results from the limited small studies however the effect of donor smokers significantly impacted the recipient survival Smoking biomarkers and kidney transplant
Cotinine is a promising biomarker for the exposure of smoking kidney transplant recipients as having a longer half-life compared to nicotine and can be measured in urine and plasma and give more objective results compared to self-reporting of smoking exposure for the former smoker but will be of limited value in recipients with occasional smoking habit, so the best would be a combination of self-reporting and cotinine level to give more accurate exposure in active smokers, former smokers and never smoke recipients as each one has a clinical correlation with graft, patient outcome, and recipient mortality.
What is the level of evidence provided by this article?
Level 5 narrative review of retrospective small sample size studies How do you help renal transplant patients to stop smoking?
Should be involved in a smoking cessation program, with group therapy and psychosocial support What is the effect of smoking on kidney donors? Donor smoking in some report significantly impact the recipient’s survival
Wadia Elhardallo
2 years ago
Smoking in Renal Transplantation; Facts Beyond Myth
Briefly summarise this article
Most of the studies focused onthe association between smoking and cardiovascular
disease, pulmonary diseases, malignancy and death.However, the direct effect of smoking on the renalsystem was undermind. There is emerging evidencecorrelating tobacco use with pathological changes inthe normal kidneys. The effect is more obvious on therenal allograft most probably due to the chronic immunesuppression status and the metabolic effect of thedrugs.
Effects of Smoking ON The Kidney:
The hazards of smoking were investigated thoroughly in association with cardiovascular disease, lung disease and oncogenesis. Pinto-Sietsma et al performed a leading cross sectional study on 7476 participants to evaluate the effect of smoking on the development of albuminuria and abnormal kidney functions in non-diabetic population. They documented the presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment in this screening.
Recipient Smoking AndTransplantation Outcome:
Ponticelli et al have addressed the role of cardiovascular disease as the leading cause of death in renal transplant recipient. The development of de novo cardiovascular insult in the first year post-transplant was associated with pre-existing cardiovascular disease,
older age, pre-transplant hypertension, smoking and duration of dialysis.
smoking also increased risk for certain types of post-transplantation malignancy. Zitt et al had a unique approach by studying the relation between smoking and renal biopsy findings of 76 kidney transplant recipients. Current smokers had an increase in the severity of vascular intimal fibrous thickening (p = 0.004). Whilethe degree of chronic sclerosing nephropathy (p = 0.05) and arteriolar hyalinosis (p < 0.001) were associated with the duration of time post-transplantation.
Most of these studies have revealed a clear benefit of smoking cessation on graft survival.
Effect of Smoking Habit ofKidney DONOR ON The Outcome ofTransplantation:
lin et al have analysed data from the United Network for Organ Sharing from 1994 to 1999 and they declared that smoking habit of the donor has mild,yet statistically significant effect on recipient survival and graft survival
Underwood et al state that The effect of donor smoking on graft survival was
statistically insignificant (unlike the recipient smoking which proved to be significant
However, the recipient survival was negatively correlated to donor smoking (HR = 1.93,
95%CI: 1.27-2.94, p = 0.002) and recipient smoking (HR= 1.74, 95%CI: 1.01-3.00, p = 0.048)
Smoking Biomarker And RenalTransplantation:
The use of smoking biomarkers proved to be reliable in evaluation and quantification of smoking exposure in the transplant population Cotinine is the major metabolite of nicotine. It has a relatively constant level due its long half-life (16 h vs2-3 h for nicotine), which can be measured in plasma or urine. For these reasons, cotinine is considered a promising biomarker of smoking exposure
What is the level of evidence provided by this article?
Level 5 * review
How do you help renal transplant patients to stop smoking?
Most the studies have revealed a clear benefit of smoking cessation on graft survival, so am going to:
Inform patients about importance of smoking cessation
Behavioural therapy and referral to specialist in smoking cessation
Group therapy , psychological support
What is the effect of smoking on kidney donors?
Donor smokingproved to have a negative impact on recipient survival statistically significant and on graft survival.
Reem Younis
2 years ago
Briefly summarise this article
– Cigarette smoking assumes to have a role in atherosclerosis, endothelial
dysfunction, progression of vascular disease progression of proteinuria, as it contains large amounts of free radicals. This makes smoking a significant renal risk
factor.
The effect of smoking is aggravated in renal transplant recipients due to the effect of immune suppression medications on carcinogenesis, in addition to the effect
of chronic kidney disease itself on cardiovascular risk and mortality.
-One study showed a significant increase in arginine vasopressin levels and serum epinephrine as the effect of smoking on healthy normotensive volunteers. Also, There was an increase in renal vascular resistance by 11% and a decrease in the
glomerular filtration rate (GFR) by 15%. They assumed these effects are secondary to nicotine itself .
-There is a dose-dependent association between smoking and development of
both microalbuminuria and renal impairment .
-Smoking is a well-known risk factor for cardiovascular disease. The development of de novo cardiovascular insult in the first year post-transplant was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and duration of dialysis.
-The second leading cause of death post-transplantation was malignancy with a clear association between smoking and increased risk for certain types of malignancy.
-Renal –transplant recipients who smoke had an increase in the severity of
vascular intimal fibrous thickening .
-Many studies have revealed a clear benefit of smoking cessation on graft survival, but the effect on patient survival is less clear possibly reflecting
the permanent atherosclerotic effect on the vascular system.
-The donor smoking will affect the recipient survival years after transplantation.
– The tobacco dose differs between individuals due to the difference between cigarettes as well as the difference in inhaling habits (passive
smoking)
-Cotinine is the major metabolite of nicotine. It has a relatively constant level due its long half-life (16 h vs 2-3 h for nicotine), which can be measured in plasma
or urine. cotinine is considered a promising biomarker of smoking exposure.
-Active smoking had a negative impact on patient and graft survival, while
former smokers had increased the risk of mortality but not graft failure.
-The combination of cotinine measurement and self-reporting of smoking exposure will be the most reliable approach in evaluating renal transplant
population. What is the level of evidence provided by this article?
Level 5 How do you help renal transplant patients to stop smoking?
By referring them to a smoking cession program. What is the effect of smoking on kidney donors?
– No difference in postoperative complications was seen in smoking versus non-smoking donors but affect kidney in the future.
Nandita Sugumar
2 years ago
Summary
This article focusses on the topic of smoking among renal transplant recipients. The direct effects on the kidneys and renal system have been studied. Pathological changes in the kidneys due to smoking have been noted.
Smoking directly affects the kidneys, besides also affecting the lungs, heart, and leading to cancer and death. Kidneys which are otherwise healthy can also be affected to a great extent from regular tobacco consumption. The renal allograft is even more affected due to the constant immunosuppression that the body is under after kidney transplant. Smoking directly lowers patient and graft survival rates. Along the same lines, cessation of this harmful habit can lead to better rates of graft survival and patient survival. This is why smoker donors are not accepted in many centers since the risk of kidney failure and death is carried over to the recipient.
Since exposure to smoke and dose analysis is mostly self reported, it is often difficult to accurately assess the impact of smoking on one particular organ system. This could possibly be remedied by the introduction of a biomarker called Cotinine. Cotinine is a major metabolite of nicotine with a long half life leading to its constant level. It can be measured in plasma or urine. However, since Cotinine can only reveal smoking exposure for the past few days, it can be misleading in some cases where patients smoke on selected days and not other days or if the patient is a strictly occasional smoker.
In addition, Cotinine cannot different between a person who never smoked to a person who smoked previously but later gave up on the habit and now is completely free from it. This is significant because the outcome of both these groups is not the same. Patients who used to smoke have a raised risk of mortality.
In conclusion, smoking is a modifiable habit and has a multi pronged effect on the human body. With respect to kidneys, it can damage renal functioning and especially cause severe stress on the allograft leading to possible graft failure and even death of the patient. More smoking cessation programs need to be created that are workable and sustainable in the long term.
Level of evidence
Narrative review – Level of evidence 5.
How to help patients overcome smoking
Counseling and education
smoking cessation programs
smoking cessation groups and regular meetings
nicotine patches and like products that help in alleviating withdrawal symptoms at least to an extent
stress management education
MICHAEL Farag
2 years ago
Smoking was associated with lowering patient and graft survival. Smoking cessation proved to improve graft survival and to a lesser extent recipient survival. Even receiving a renal transplant from a smoker donor increases the risk of death for the recipient and carries a poorer graft survival compared to non-smoking donors
What is the level of evidence provided by this article?
Level V
How do you help renal transplant patients to stop smoking?
– Education about the risk of smoking on the graft and on the life outcome in general – Referral to smoking cessation team, and may need psychological support. • What is the effect of smoking on kidney donors? receiving a renal transplant from a smoker donor increases the risk of death for the recipient and carries a poorer graft survival compared to non-smoking donors. Furthermore; it increases the risk of cardiovascular and pulmonary diseases; hence, high risk of mortality
Huda Al-Taee
2 years ago
Briefly summarise this article
Smoking is a challenging health care problem; it has a well-established correlation with many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death.
The effect of smoking is aggravated in renal transplant recipients due to the effect of immunosuppressive medications on carcinogenesis, in addition to the effect of chronic kidney disease itself on cardiovascular risk and mortality.
Effects of smoking on the kidney:
A study to evaluate the effect of smoking on the development of albuminuria and abnormal kidney functions in the non-diabetic population found the presence of a dose-dependent association between smoking and the development of both microalbuminuria and renal impairment. These findings were less obvious or absent in former smokers.
Recipient smoking and transplantation outcome:
Complications of smoking are aggravated in solid organ transplant recipients.
The development of de novo cardiovascular insult in the first year post-transplant was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and duration of dialysis.
There is a clear association between smoking and increased risk for certain types of malignancy.
A study evaluated the relation between smoking and renal biopsy findings of 76 kidney transplant recipients. Current smokers increased the severity of vascular intimal fibrous thickening, and the degree of chronic sclerosing nephropathy and arteriolar hyalinosis was associated with the duration of time post-transplantation.
Effect of the smoking habit of kidney donors on the outcome of transplantation:
Even donor smoking will affect the recipient’s survival years after transplantation.
Data from UNOS showed that the smoking habit of the donor has a mild yet statistically significant effect on recipient survival and graft survival.
Another study showed that recipients of smoking donors had a lower GFR at a mean follow-up of 38 months.
Smoking biomarker and renal transplantation:
Cotinine is the major metabolite of nicotine. It has a relatively constant level due to its long half-life, which can be measured in plasma or urine. For these reasons, cotinine is considered a promising biomarker of smoking exposure.
A study showed that active smoking had a negative impact on patient and graft survival; former smokers had increased the risk of mortality but not graft failure. They documented that cotinine measurement provides a valid alternative to self-reported smoking exposure, and it may even be preferred over self-reporting in epidemiological studies.
Limitations of using cotinine:
Cotinine level is a reflection of smoking over the past few days, and this may be misleading if the patient is occasionally smoking (like at weekends) or if the patient was smoking less due to a period of illness.
its inability to differentiate between never-smoking and former-smoking.
A combination of cotinine measurement and self-reporting of smoking exposure will be the most reliable approach to evaluating renal transplant population.
What is the level of evidence provided by this article?
Level 5 (review article)
How do you help renal transplant patients to stop smoking?
patient education about the risks of smoking.
patient enrollment in behavioural therapy for smoking cessation.
nicotine alternatives like nicotine patches.
Numerous technological interventions (websites, applications, SMS, video games, social media) are emerging on the market to help smokers quit.
What is the effect of smoking on kidney donors?
Smoking is associated with a short-term risk of developing CKD.
Zahid Nabi
2 years ago
Smoking is a challenging health care problem; it has a well-established correlation with many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death. There is not enough high quality research data on effect of smoking in kidney transplant patients. It has been shown in different studies that smoking leads to increased albuminuria,reduces GFR and can lead to progression of intrinsic kidney diseases like IgA Nephropathy, ADPKD and Diabetic Nephropathy.
Cardiovascular disease and malignancy are two leading causes of death in post kidney transplant patients and smoking is well known risk factor for both these conditions.The available limited data has shown clear benefit of smoking cessation on graft survival but not on patient survival.
The effect of donor smoking on graft survival has shown statistically significant effect in one study however it was insignificant in another study done by underwood and colleagues.
Cotinine is the major metabolite of nicotine. It has a relatively constant level due to its long half-life (16 h vs 2-3 h for nicotine), which can be measured in plasma or urine. For these reasons, cotinine is considered a promising biomarker of smoking exposure as self reporting has many limitations.
The use of cotinine also has its limitations. Cotinine level is a reflection of smoking over the past few days, and this may be misleading if the patient is smoking occasionally (like in weekends) or if the patient was smoking less due to a period of illness. The second limitation lies in its inability to differentiate between never-smoking and former-smoking. Differentiating never-smoking from former-smoking is clinically relevant as former-smoking was proved to be associated with increasing risk of recipient mortality.
I think in view of above all smoking cessation programs should be incorporated as part of kidney transplant work up
Narrative review evidence level v.
we should explain patients about deleterious effects of smoking on graft and patient outcome and also adopt a smoking cessation program for such patients.
Smoking will increase risk of albuminuria, low GFR for kidney donors further it is an independent cause of increased Cardiovascular mortality
Hussam Juda
2 years ago
INTRODUCTION
· It’s known that smoking is one of the leading causes of cardiovascular diseases, pulmonary diseases, malignancy and death.
· smoking free radicals have a role in atherosclerosis, endothelial dysfunction, progression of vascular disease and proteinuria
· smoking effect more serious in transplant recipients due to the effect of immune suppression drugs on carcinogenesis and CKD effect on cardiovascular risk and mortality
Effects of smoking on the kidney
· the effect of smoking on healthy kidney and progression of primary kidney diseases is neglectable
· smoking could have a role in the progression of diabetic nephropathy, IgA nephropathy and autosomal dominant polycystic kidney disease
· Ritz et al found that smoking increased renal vascular resistance by 11% and a decreased the glomerular filtration rate (GFR) by 15%
Recipient smoking and transplantation outcome
· Many studies have revealed a clear benefit of smoking cessation on graft survival, but not on patient survival, maybe due to permanent atherosclerotic effect on the vascular system Effect of smoking habit of kidney donor on the outcome of transplantation
· Lin et al found that smoking habit of the donor has mild, yet statistically significant effect on recipient survival, and graft survival
· While Underwood et al found that the effect of donor smoking on graft survival was statistically insignificant, unlike the recipient smoking which proved to be significant
· the recipients of smoking donors had lower calculated GFR (Heldt et al)
Smoking biomarker and renal transplantation
· Cotinine is the major metabolite of nicotine
· Cotinine has a relatively constant level due its long half-life, which can be measured in plasma or urine
· Hellemons et al documented that cotinine measurement provides a valid alternative to self-reported smoking exposure, and it may even be preferred over self-reporting in epidemiological studies
· Limitations of Cotinine use:
1. if the patient is smoking occasionally or if the patient was smoking less due to a period of illness
2. cannot differentiate between never-smoking and former-smoking
· The authors believe that the combination of cotinine measurement and self-reporting of smoking exposure will be the most reliable approach in evaluating renal transplant population
Conclusion
· Smoking is the leading cause of variable morbidities and mortality.
· The use of smoking biomarkers proved to be reliable in evaluation and quantification of smoking exposure in the transplant population.
· Donor smoking and recipient former smoking proved to have a negative impact on survival. Transplant community should pursue donor and recipient to quit smoking
What is the level of evidence provided by this article?
Narrative review with evidence level 5
How do you help renal transplant patients to stop smoking?
Clarify risk of smoking on graft and mortality
enrolment in smoking cessation programs
then pharmacological therapies (nicotine patches or gum, bupropion, varenicline and cytisine).
What is the effect of smoking on kidney donors?
Higher death rate in kidney donors with cigarette smoking
More perioperative complications
More postoperative wound infections
Active smoker or past history of smoking has high creatinine at end of 1 year as compared to the nonsmoker.
abosaeed mohamed
2 years ago
Introduction :
– Smoking is one of the preventable leading causes of death worldwide
– Smoking is a challenging health care problem; it has a well-established correlation with many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death
– There are emerging evidence correlating tobacco use with pathological changes in the normal kidneys. The effect is more obvious on the renal allograft most probably due to the chronic immune suppression status and the metabolic effect of the drugs. Several studies have documented a deleterious effect of smoking on the renal transplant recipients. Smoking was associated with lowering patient and graft survival. Smoking cessation proved to improve graft survival and to a lesser extent recipient survival. Even receiving a renal transplant from a smoker donor increases the risk of death for the recipient and carries a poorer graft survival compared to non-smoking donors.
Effects of smoking on the kidney
– many studies confirmed the role played by smoking in the progression of many intrinsic renal diseases (e.g., diabetic nephropathy, IgA nephropathy and autosomal dominant polycystic kidney disease)
– Pinto-Sietsma et al documented the presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment in this screening. These findings were less obvious or absent in former smokers
Recipient smoking and transplantation outcome
– Smoking is a well-known risk factor for cardiovascular disease. Ponticelli et al have addressed the role of cardiovascular disease as the leading cause of death in renal transplant recipient.
– The development of de novo cardiovascular insult in the first year post-transplant was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and duration of dialysis .
– The second leading cause of death post-transplantation was malignancy with a clear association between smoking and increased risk for certain types of malignancy .
Effect of smoking habit of kidney donor on the outcome of transplantation
– It may be logic that the recipient smoking will affect his own survival, but surprisingly, even the donor smoking will affect the recipient survival years after transplantation
Smoking biomarker and renal transplantation
– cotinine is considered a promising biomarker of smoking exposure.
– Hellemons et al studied 603 renal transplant recipients for a mean follow-up of 6.9 years. The aim was to investigate the relation of self-reporting and cotinine exposure in transplant population and to evaluate the use of cotinine as an alternative for self report . They concluded that active smoking had a negative impact on patient and graft survival, while former smokers had increased the risk of mortality but not graft failure. They documented that cotinine measurement (especially plasma cotinine) provides a valid alternative to self-reported smoking exposure, and it may even be preferred over self-reporting in epidemiological studies .
Conclusion
– Smoking remains a major modifiable health care challenge; it is the leading cause of variable morbidities and mortality. The use of smoking biomarkers proved to be reliable in evaluation and quantification of smoking exposure in the transplant population. Donor smoking and recipient former smoking proved to have a negative impact on survival. Transplant community should pay more attention to donor and recipient smoking cessation programs
– Level of evidence >>> level 5
– How do you help renal transplant patients to stop smoking?
– Counselling regarding hazards & effects of smoking & its impact on the graft survival
– Direct them to smoking cessation programs which include behavioural & pharmacological therapy
– What is the effect of smoking on kidney donor ?
-smoking is associated with atherosclerosis & CV morbidity which in turn will carry high risk to the kidney donors especially being solitary kidney
– smoking is associated with risk of malignancy ( lung cancer & bladder cancer )
-smoking will increase possibility of proteinuria which is associated with increased all cause mortality
– smoking cause rapid fall in GFR than non smoker
-smoking increase risks of perioperative complications
Theepa Nesam
2 years ago
Smoking has impact on both patient and graft survival and graft survival improves after smoking cessation.
Donor smoking increases the risk of death for the recipient and negatively impacts graft survival.
Effects of smoking on the kidney
progression of many intrinsic renal diseases (e.g., diabetic nephropathy, IgA nephropathy & ADPKD) are well known.
smoking increases serum levels of AVP & epinephrine, renal vascular resistance, & decrease eGFR by 15%
associated with a dose dependent microalbuminuria & renal impairment in non-diabetic population
Recipient smoking & transplantation outcome
Smoking is an independent risk factor for CVD as we know CVD is the leading cause of death in renal transplant patients
Malignancy is the 2nd leading cause of death post-transplantation- smoking increases the risk
Smoking increases the severity of vascular intimal fibrous thickening on renal biopsy
There is a clear benefit of smoking cessation on graft survival; the effect on patient survival is less clear.
Effect of smoking habit of kidney donor on the outcome of transplantation:
Smoking habit of the donor has mild, but statistically significant effect on recipient survival & graft survival (Lin et al).
Underwood et al showed effect of donor smoking on graft survival was statistically insignificant, unlike the recipient smoking which proved to be significant.
The recipients of smoking donors had lower calculated GFR at a mean follow-up of 38 months
Smoking biomarker & renal transplantation
Cotinine (the major metabolite of nicotine) is a promising biomarker of smoking exposure. It has a longer half-life (16 h vs 2-3 h for nicotine) & can be measured in plasma or urine.
Plasma cotinine measurement provides a valid alternative to self-reported smoking exposure
What is the level of evidence provided by this article?
Level V
How do you help renal transplant patients to stop smoking?
offer smoking cessation programmes (SCPs) to all renal transplant candidates who are using tobacco products.
recommend smoking cessation at least 1 month before waitlisting
patients who continue to smoke to be eligible for KT with full informed consent regarding their increased risk of poorer outcomes.
Eusha Ansary
2 years ago
Briefly summarise this article
Smoking is modifiable health risk factor associated with lowering patient and graft survival. Smoking cessation proved to improve graft survival and to a lesser extent recipient survival. Even receiving a renal transplant from a smoker donor increases the risk of death for the recipient and carries a poorer graft survival compared to non-smoking donors.
The effect of smoking is more in renal transplant recipients due to the effect of immune suppression medications on carcinogenesis and chronic kidney disease itself increase cardiovascular risk and mortality.
Recipient smoking will affect his own survival as well as donor smoking will affect the recipient survival years after transplantation.
Cotinine is considered a promising biomarker of smoking exposure as it is the major metabolite of nicotine. It has a relatively constant level due its long half-life and can be measured in plasma or urine. Cotinine is not reliable if the smoking is occasional or curtailed during illness. So, combining self-reporting of smoking with serum cotinine level would be helpful in evaluating transplant recipients.
What is the level of evidence provided by this article?
Level of evidence: level 5 (narrative review)
How do you help renal transplant patients to stop smoking?
– Counselling about the effect of smoking on their cardiovascular and pulmonary system, as well as its effects on the graft kidney. – Smoking cessation programs include behavioral and pharmacological therapies (nicotine patches, bupropion, etc).
Briefly summarise this article
This article nicely reviews the available evidence on effects of smoking in renal transplantation.
Smoking has major deleterious effects of various organs of body. this is a well established fact in normal individuals. The common known side effects are atherosclerosis, vascular endothelial dysfunction and malignancies. But there is limited data , whether smoking causes much more serious effects on transplant recipients in comparision to normal individuals and does smoking in donors can also affect transplant outcomes.
Available studies as tabulated in the article are mostly retrospective and non-randomized.
Studies have shown that smoking also has direct effect on kidneys and this happens in dose dependent manner. More is the smoking, more are the chances of developing renal impairment and microalbuminuria.
There are three main effects of recipient smoking post transplantation:
Increased risk of cardiovascular disease
Post transplantation malignancy
more chances of vascular intimal fibrous thickening as detected in graft kidney biopsy
There is also surprising evidence that donor smoking affects recipient survival post transplantation.
Analysis of smoking exposure in transplant recipients is usually inaccurate as it depends on data collected using self-reporting methods. Hence, there is need for a biomarker which can help removing this bias.
Cotinine which is metabolite of nicotine has shown promising prospects in this due to its constant level and long half life. But it has its own limitations.
Hence, a combination approach of cotinine estimation and self reporting can be quite reliable method of analysing effect of smoking in renal transplantation.
What is the level of evidence provided by this article?
It is level 3 evidence
How do you help renal transplant patients to stop smoking?
A good effective counselling and enrolling patient for regular counselling sessions for life style modification of risk factors is the key to its success. In India there is no structured program for smoking cessation.
Therefore, I would councel patient myself on his follow ups and refer him to councilor as well for smoking cessation
What is the effect of smoking on kidney donors?
kidney donors will survive as solitary kidney candidates after donation. So they are likely to face more side effects than a person with both native kidney faces due to smoking:
Progressive increase in microalbuminuria
faster fall in GFR
Perioperative complications like wound infections
Khalil MAM, Tan J, Khamis S, Khalil MA, Azmat R, Ullah AR. Cigarette Smoking and Its Hazards in Kidney Transplantation. Adv Med. 2017;2017:6213814. doi: 10.1155/2017/6213814. Epub 2017 Jul 27. PMID: 28819637; PMCID: PMC5551477.
amiri elaf
2 years ago
#Briefly summarise this article
# Introduction
*Smoking may lead to many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death.
*It has a role in atherosclerosis, endothelial dysfunction, progression of vascular disease progression of proteinuria, as it contains large amounts of free radicals.
*The effect of smoking is aggravated in KTR due to the effect of immune suppression
drugs on carcinogenesis, also the effect of CKD itself on cardiovascular risk and mortality.
# Effects of smoking on the kidney
*Many studies showed the role of smoking in the progression of many intrinsic renal diseases (e.g, diabetic nephropathy, IgA nephropathy and APKD), they reported a significant increase in arginine vasopressin levels (from 1.27 ± 0.72 to 19.9 ± 27.2 pg/ml) and serum epinephrine (from 37 ± 13 to 140 ± 129 pg/ml).
*There was an increase in renal vascular resistance by 11% and a decrease in the (GFR) by 15%.
*They documented the presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment, these findings were less obvious or absent in former smokers.
#Recipient smoking and transplantation outcome
*Smoking is a well-known risk factor for CVD. Ponticelli et al. showed the role of CVD as the leading cause of death in KTR.
*The development of de novo cardiovascular insult in the first year post-transplant
was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and duration of dialysis.
*The second leading cause of death post-transplantation was malignancy.
*Current smokers had an increase in the severity of vascular intimal fibrous thickening Most of studies showed clear benefit of smoking cessation on graft survival, but the effect
on patient survival is less clear possibly reflecting the permanent atherosclerotic effect on the vascular system.
# Effect of smoking habit of kidney donor on the outcome of transplantation
*Lin et al conducted that that smoking habit of the donor has mild, yet statistically significant effect on recipient survival.
*The effect of donor smoking on graft survival was statistically insignificant unlike the recipient smoking which proved to be significant
*Heldt et al reported that the recipients of smoking donors had lower calculated GFR at a mean follow-up of 38 months.
# Smoking biomarker and renal transplantation
*Smoking evaluation depends on self-reporting in most of the studies which we strongly believe it lacks accuracy.
*Evaluation of the risk of tobacco depends on accurate measurement of exposure, which may be difficult in certain population.
*Cotinine is the major metabolite of nicotine, it has a relatively constant level due its long half-life (16 h vs 2-3 h for nicotine) and can be estimated in the plasma and urine, for these reasons, cotinine is considered a promising biomarker of smoking exposure.
# What is the level of evidence provided by this article?
*Level 5
# How do you help renal transplant patients to stop smoking?
*Kidney donors and recipients with history of cigarette smoking should be referred to smoking cessation clinics, and they should be counseling about all the risk and outcome of recipients, donors and the graft.
The use of combination of cotinine measurement and self-reporting of smoking exposure will be the most reliable approach in evaluating renal transplant population.
# What is the effect of smoking on kidney donors?
*Kidney donors undergo general anesthesia for donor nephrectomy and are prone to develop complications in the perioperative period. *Cigarette smoking causes increased bronchial secretion and impaired mucociliary clearance.
*It also results in increased carboxyhemoglobin and secondary polycythemia.
*Pneumonia is the third most common infection after urinary tract and wound infection in kidney donors.
*Smokers have a higher risk of pulmonary and wound infections after surgery than nonsmokers.
*Amsterdam Forum Guidelines recommends cessation of cigarette smoking 6 weeks before kidney donation.
*There is a significantly higher death rate among kidney donors who were smokers.
*Cigarette smoking in cadaveric kidney donor may be associated with DGF.
*kidney donors who actively smoke or have a past history of tobacco use were found to have higher serum creatinine at end of 1 year as compared to non smokers.
*Recipients of kidneys from smokers had higher creatinine and lower GFR.
*However, Jha et al. found no difference in postoperative complications and graft survival between the two groups.
*Donor cigarette smoking reduced recipient survival.
For live kidney donors, transplantation provides an opportunity to quit cigarette smoking.
marius Badal
2 years ago
The article deals with smoking and transplant. Smoking is one of the leading causes of death that is preventable. Numerous studies have been conducted to associate smoking with other pathologies like cardiovascular diseases, peripheral vascular diseases, pulmonary diseases, malignancies like bladder, etc. most recent studies have correlated smoking with kidney diseases. It is also found that smoking aggravates renal transplant recipients due to immunosuppressive medications and possible carcinogenesis. Due to the cardiovascular effects, it has it can directly affect the kidneys causing CKD.
The effect of smoking on the kidneys; it has been found that smoking has an effect on the cardiovascular system causing cardiovascular diseases and peripheral diseases. Not only in this aspect but also affects the lungs and other systems. However, its effect on healthy kidneys and the progression of primary kidney diseases did not show much evidence.
Effects of smoking on recipient and transplant: smoking has strong implications on the transplant graft as it can aggravate its function and may lead to organ failure. These effects can be fatal. It is one of the leading risk factors for cardiovascular diseases in KT. Smoking is also correlated with malignancy in patients post-transplant and is a leading cause of death.
It is also noted that not only the recipient that smoking does affect but also donors. Due to the long-standing habit of smoking, the donor’s toxic habit will later have an effect on the graft survival years post-transplantation.
Smoking biomarker and renal transplant: cotinine is the major metabolite of nicotine from smoking. It has a long half-life of about 16 hours – 2-3 hours for nicotine. These biomarkers can be measured in the urine and plasma. Due to the long hours in the plasma, it is an ideal biomarker for smoking exposure.
Cotinine itself has its limitations. It reflects smoking has taken place a few days earlier and may not distinguish if smoking occurred during a period of illness or on weekends. It is difficult to know or differentiate between a person who never smokes or a former smoker.
How then do we encourage or help renal transplant patients to stop smoking:
Firstly, patient education is fundamental. The patient must know the consequences of smoking the graft, like failure and other complications. Once this is done objective studies must be conducted to provide evidence that smoking may have or the effect it may have on the GFRAT. So studies like cardiac evaluation, Xray, PFT and CPET.
Once the patient has understood the possible complications and outcomes, treatment must be provided to cease smoking and they are as follows:
1) Smoking cessation program
2) Have a smoking patch like the nicotine patch. Chewing gums
3) Group therapy
4) Referred to a psychologist
the level of evidence is 5
Rahul Yadav rahulyadavdr@gmail.com
2 years ago
Briefly summarize this article
Smoking and effect on renal system especially in transplant population is less studied and most studies are retrospective and/or with small sample size.
Effect of smoking on kidneys:
Role of smoking in progression of intrinsic renal disease (IgA nephropathy, ADPKD, Diabetic nephropathy) has been confirmed in many studies.
Smoking effects in healthy volunteers has been studied by Ritz et al and found that level of arginine vasopressin and serum epinephrine was elevated in smokers. Increase in Renal vascular resistance by 11% and decrease in GFR by 15% found in smoking group.
Pinto-Sietsma et al demonstrated dose dependent association between smoking and development of microalbuminuria.
Effect of Recipient smoking and transplant outcome:
Cardiovascular disease and malignancy are leading cause of death in recipients and smoking has clear association between both in various studies.
Smoking increases severity of vascular intimal fibrous thickening in a unique study by Zitt etal which examines kidney biopsy. Graft survival and smoking cessation has a clear benefit.
Effect of smoking in kidney donor on Transplant Outcome:
There are mixed results of Donor smoking on Graft survival in few available studies. In a study by Heldt et al documented that recipients of smoking donors had lower calculated GFR at mean follow up of 38 months (37 versus 53 ml/min per 1.73m2)
Biomarkers of Smoking and Renal transplantation:
Smoking exposure and analysis of dose of smoking lacks accuracy. Accurate measurement of exposure is difficult due to recall bias, difference of tobacco dose and inhalation pattern.
Due to above lacuna, there is need of an accurate and valid biomarker of smoking.
Cotinine, a major metabolite of nicotine has half-life of 16 versus 2-3 hours of nicotine, is one such biomarkers but has few limitations. It can’t differentiate between occasional, never smoker, former smokers, and less frequent smokers.
Biomarker along with self-reported nicotine exposure will be best approach of evaluating effects of smoking on renal transplant.
Smoking is a major preventable factor which have negative impact on survival
What is the level of evidence provided by this article?
This is a narrative review of majorly Retrospective studies; hence level of evidence is 5.
How do you help renal transplant patients to stop smoking?
Educating renal transplant recipient in detail about association between smoking and cardiovascular, pulmonary diseases, proteinuria, malignancy, and negative impact on graft survival.
Also, it is important to mention here, effect of smoking is aggravated in recipients due to prior effect of CKD on cardiovascular system and relationship between immunosuppression and carcinogenesis which increases morbidity and mortality.
What is the effect of smoking on kidney donors?
Smoking predisposes Kidney Donors to its adverse effects on major systems of the body and adversely effects graft survival and GFR in recipients.
AHMED Aref
2 years ago
Briefly summarise this article
What is the level of evidence provided by this article?
This is a narrative review article which is considered level 5.
The article discussed the deleterious effect of smoking on the native and transplanted kidney, a hidden and underestimated complication of smoking. The take-home message includes:
· Smoking proved to have a negative impact on the hemodynamics of both normal kidney as well as kidney allograft and was correlated with the development of microalbuminuria and renal impairment.
· Smoking was associated with worse patient and allograft outcomes.
· Patients who quit smoking before transplantation had clear benefits regarding patient and graft survival compared to those who continue to smoke.
· Recipients of kidney allograft from a smoker living donor have a lower patient and allograft survival than recipients of kidney allograft from non-smoker donors.
· The development of a valid and accurate biomarker for tobacco smoking is essential as most of the studies rely on self-reporting of the participants, which may be inaccurate either due to recall errors or deliberately hiding the exact smoking habit for social reasons (e.g. in pregnant females).
· Cotinine (the major metabolite of nicotine) was introduced as a promising biomarker to evaluate the smoking dose. It has a longer half-life than nicotine (16 h vs 2-3 h for nicotine). However, it has its limitations as it can don’t differentiate ex-smokers from those who never smoke, it can not detect if the patient is occasionally smoking, and finally, it will miss the diagnosis of smokers who stopped smoking for the past few days only due to causes other than quitting smoking permanently (e.g. during an episode of illness).
How do you help renal transplant patients to stop smoking?
Kidney allograft recipients are usually anxious regarding the allograft function, and they wish to preserve a well-functioning allograft for the longest possible time. Our approach is to ensure that the patient realised the fact that smoking will not only affect his survival, but it may end by losing his transplanted kidney sooner than expected; at that point, we have his full attention, and then we will refer him to smoking cessation activities which will help him during the journey to quit smoking.
What is the effect of smoking on kidney donors?
Kidney donors will have the same increased risk of cardiovascular disease, pulmonary diseases, malignancy and death as the general population. Additionally, they will have a higher chance of deterioration of functions of the remaining kidney due to the augmentation of the physiological haemodynamic disturbance occurring in the remaining kidney during the compensation period after a sudden drop of GFR post-donation.
Muntasir Mohammed
2 years ago
Briefly summarise this article
INTRODUCTION
Smoking is a challenging health care problem; it has a well-established correlation with many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death. Cigarette smoking assumes to have a role in atherosclerosis, endothelial dysfunction, progression of vascular disease and progression of proteinuria.
The effect of smoking is aggravated in renal transplant recipients due to the effect of immune suppression medications on carcinogenesis, in addition to the effect of chronic kidney disease itself on cardiovascular risk and mortality.
Effects of smoking on the kidney
The hazards of smoking were investigated thoroughly in association with cardiovascular disease, lung disease and oncogenesis. However, the effect of smoking on healthy kidney and progression of primary kidney diseases did not attract great attention.
Recipient smoking and transplantation outcome
Smoking is strongly correlated to some of the potentially fatal outcomes, and there is some evidence that these complications are aggravated in solid organ transplant recipients.
Smoking is a well-known risk factor for cardiovascular disease
The second leading cause of death post-transplantation was malignancy with a clear association between smoking and increased risk for certain types of malignancy.
Effect of smoking habit of kidney donor on the outcome of Transplantation
It may be logic that the recipient smoking will affect his own survival, but surprisingly, even the donor smoking will affect the recipient survival years after transplantation.
Smoking biomarker and renal transplantation
Smoking exposure and analysis of dose of smoking depends on self-reporting in most of the studies. which we strongly believe it lacks accuracy. Proper estimation of the risks associated with tobacco use depends on accurate measurement of exposure, which may be difficult in certain population such as pregnant women and parents of young children, where smoking considered socially unaccepted. Some patients may not recall the number of cigarettes accurately (digit bias) and finally the tobacco dose differs between
individuals due to the difference between cigarettes as well as the difference in inhaling habits. Cotinine is the major metabolite of nicotine. It has a relatively constant level due its long half-life (16 h vs 2-3 h for nicotine), which can be measured in plasma
or urine. For these reasons, cotinine is considered a promising biomarker of smoking exposure. The use of cotinine also has its limitations. Cotinine level is a reflection of smoking over the past few days, and this may be misleading if the patient is smoking
occasionally (like in weekends) or if the patient was smoking less due to a period of illness. The second limitation lies in its inability to differentiate between never-smoking and former-smoking. We believe that the combination of cotinine measurement
and self-reporting of smoking exposure will be the most reliable approach in evaluating renal transplant population.
What is the level of evidence provided by this article?
Level 4, review article.
How do you help renal transplant patients to stop smoking?
By education about its effect on graft. Smoking cessation clinics Nicotine patch and gum.
What is the effect of smoking on kidney donors?
Smoking and obesity reduced life expectancy and increased overall lifetime risks of ESRD in non-donors. However the percentage loss of remaining life years from donation was not very different in those with or without these risk factors. Differences between postoperative complications were insignificant between smoking and nonsmoking donors . The most common complication was ileus at 6.73% in non-smoking donors and 5.13% in smoking donors. Surgical site infection, urinary retention, and urinary tract infection (UTI) were other common complications with rates under 5%.
References: 1-Clin Transplant 2014: 28: 419–422 DOI: 10.1111/ctr.12330 2-Kiberd BA, Tennankore KK. BMJ Open 2017;7:e016490. doi:10.1136/bmjopen-2017-016490
Dr. Tufayel Chowdhury
2 years ago
Introduction:
Smoking is a challenging health care problem.
Effects of smoking on kidney:
Many studies confirmed that smoking play role in progression of many intrinsic renal disease. Ritz et al found that there was increase in renal vascular resistance by 11% and a decrease in the GFR by 15%. Pinto Sietsma et al found a dose dependant association between smoking and development of both microalbuminuria and renal impairement.
Recipient smoking and transplant outcome:
Smoking is strongly correlated to some of the potentially fatal outcome.Ponticilli et al found that de novo development of cardiovascular insult in first year of post transplant has association with smoking.Post transplant malignancy has also association with smoking.
Most studies revealed a clear benefit of smoking cessation on graft survival.
Smoking biomartkers
Cotinine, a major metabolite of nicotine, which can be measured in plasma or urine, is a promising biomarkers of smoking expopsure, with some limitations.
Conclusion
Smoking remains a major modifiable health care challenge.
I will councell the patient regarding hazards of smoking and send them to smo9king cessation programme.
Effect of smoking on donor.
Causes decrease GFR and chances of cardiovascular morbidity and mortality and chance of malignency increas.
Filipe prohaska Batista
2 years ago
It is a Narrative Review – Level 5
This study exposes the role of smoking in kidney transplantation and its impact on the individual and the graft.
The absence of a long-term biomarker, the role of passive smoking, and the need for a well-taken anamnesis with robust data limits our knowledge of the impact and consumption of the individual, with smoking history being the pattern in the studies, making meta-analyses difficult.
In the general population, smoking brings a series of limitations, whether cardiovascular (atherosclerosis, peripheral arterial disease, venous insufficiency, deep vein thrombosis), pulmonary (chronic obstructive pulmonary disease, pulmonary emphysema, restrictive pattern, and limitation), neoplastic (various types of cancers). related, well beyond pulmonary, head and neck, skin, intestinal, etc.), nutritional, and genetic diseases (polycystic kidney, IgA nephropathy, diabetic nephropathy).
Associated with so many changes, some factors are specific to transplant patients. Intimate fibrous endothelial alterations, sclerosis nephropathy, and arteriolar hyalinosis are more frequent findings in smokers, with improvement in histopathological findings with smoking cessation. Drug interactions should also be considered, impacting the quality of immunosuppression and increasing the risk of graft rejection. There are even studies that report that smoking donors provide less effective grafts.
Perioperative and wound healing complications are much worse in smoking patients compared to the general population. Smoking cessation has several impacts on morbidity and mortality of both the donor and the recipient and the people around them.
There is a need for a multidisciplinary team, including psychologists and group care support, aiming at smoking cessation.
Amit Sharma
2 years ago
Briefly summarise this article
Association of smoking with cardiovascular and pulmonary disease, malignancy and mortality are well known. The renal effects of smoking are not well emphasized. Tobacco has pathological effects on native as well as graft kidneys, especially due to immunosuppression.
Smoking, through effects of nicotine, leads to increased arginine vasopressin, increased epinephrine, increased renal vascular resistance, microalbuminuria and reduced GFR. Smoking is associated with progression of renal diseases like diabetic nephropathy, IgA nephropathy and ADPKD. The cardiovascular insults seen in first year post-transplant are associated with a pre-existing cardiovascular disease, older age, hypertension, dialysis vintage and smoking. Smoking is also associated with increased risk of malignancies. A kidney biopsy in a current smoker reveals increased severity of vascular intimal fibrous thickening and the degree of chronic sclerosing nephropathy with arteriolar hyalinosis is more with increased duration of smoking time post-transplant.
Smoking has been shown to be associated with reduced patient and graft survival and its cessation improves graft survival, although there is no effect on the patient survival (due to underlying atherosclerosis). Smoking has been shown to be associated with increased risk of acute rejection. The GFR, graft and patient survival in a recipient of kidney from a smoker is lower than that from a non-smoker.
Cotinine is a metabolite of nicotine with increased half-life and potential to be used as biomarker of smoking exposure over past few days. Cotinine is not reliable if the smoking is occasional or curtailed during illness. So, combining self-reporting of smoking with serum cotinine levels would be helpful in evaluating transplant recipients.
What is the level of evidence provided by this article?
Level of evidence: level 5 (narrative review)
How do you help renal transplant patients to stop smoking?
Patients need to be counselled about the effect of smoking on their cardiovascular and pulmonary system, as well as its effects on the graft kidney. They should be encouraged to quit smoking at least 4 weeks prior to the transplant and it should be re-enforced on each OPD follow-up visit post-transplant. They may be referred for enrolment in smoking cessation programs utilizing behavioural and pharmacological therapies (nicotine patches, bupropion, varenicline and cytisine).
What is the effect of smoking on kidney donors?
Smoking on a kidney donor has 2-fold effects.
Effects on the graft kidney from a smoker:
a) Reduced GFR
b) Reduced graft survival
c) Reduced patient survival
Effects on the donor:
a) Increased peri-operative complications
b) Increased chronic sclerosis nephropathy in the remaining kidney, having poor renal outcomes, fall in GFR leading to CKD later-on.
c) More post-operative wound infections
d) Increased mortality due to underlying atherosclerosis
e) Increased risk of malignancy, pulmonary disease, and cardiovascular disease
Mohamad Habli
2 years ago
Smoking is well known modifiable risk factor for cardiovascular complications and mortality. Smoking is a preventable cause of death worldwide.
Smoking risk is attributed to its effect on vascular system by inducing or potentiation endothelial dysfunction, progression atherosclerosis and proteinuria, on top of cardiovascular side effects caused by immunosuupressive medications.
The effects of smoking on kidneys were addressed in many studies including transplant and non-transplant population.
In healthy volunteers smoking was associated with increase in serum arginine vasopression and increase in epinephrine level leading to intra-renal vasoconstriction with a subsequent reduction in GFR.
Smoking was also shown to be associated increased in albuminuria and abnormal renal function in non-diabetic patients.
In kidney transplant recipients smoking is a well-known risk factor for development of cardiovascular disease. It is also associated with de-novo cardiovascular disease in the first year post-transplantation.
Current smoking post transplantation have been linked to increased severity of vascular intimal fibrosis.
Few studies reported worse allograft survival in patients with tobacco use compared to non-smokers.
In conclusion ;
Smoking carried deleterious adverse events in patient with kidney transplantation. Current smokers at high risk of cardiovascular complications and graft loss.
What is the level of evidence provided by this article?
Level of evidence 5
How do you help renal transplant patients to stop smoking?
Smoking sessation is advised in the pre-transplant period during initial assessment. Smoking sessation is achieved via cognitive behavioral therapy in addition to pharmacological treatment.
Pharmacological treatment includes nicotine replacement drugs, Bupropion, varenicline and cytisine.
Nahla Allam
2 years ago
Summary: INTRODUCTION:
Ø Smoking is a challenging health care problem; it has a well-established correlation with many severe medical conditions like cardiovascular diseases, pulmonary diseases, malignancy, and death. In addition, cigarette smoking assumes a role in atherosclerosis, endothelial dysfunction, and progression of vascular disease progression of proteinuria.
Ø The effect of smoking is aggravated in renal transplant recipients due to the development of immune suppression medications on carcinogenesis and the impact of chronic kidney disease on cardiovascular risk and mortality.
Ø The effect of smoking on the healthy kidney :
1. increase in arginine vasopressin levels
2. increase serum epinephrine
3. increase in renal vascular resistance by 11%
4. decrease in the glomerular filtration rate (GFR) by 15%.
Ø Recipient smoking and transplantation outcome:
· Smoking is a well-known risk factor for cardiovascular disease
· The development of de novo cardiovascular insult in the first year post-transplant
was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking, and duration of dialysis
· The second leading cause of death post-transplantation was malignancy. With a clear association between smoking and increased risk for certain types of
Malignancy
· Increase in the severity of vascular intimal fibrous thickening.
· The effect of smoking on renal transplant recipients was investigated in relatively few studies, most of which are retrospective. Table 1 summarises the result of most of these studies.file:///C:/Users/user/AppData/Local/Temp/msohtmlclip1/01/clip_image002.gif
Effect of the smoking habit of kidney donors on the outcome of transplantation:
Ø It may be logical that the recipient’s smoking will affect his survival, but surprisingly, even the donor
Ø smoking will affect the recipient’s survival years after transplantation
Ø they declared that the smoking habit of the donor has a mild yet statistically significant effect on recipient survival
Ø The impact of donor smoking on graft survival was statistically insignificant, unlike the recipient smoking, which proved to be significant
Ø the recipients of smoking donors had lower calculated GFR
Smoking biomarker and renal transplantation:
Ø Cotinine is the major metabolite of nicotine. In addition, it has a relatively constant level due to its long half-life (16 h vs. 2-3 h for nicotine), which can be measured in plasma or urine. For these reasons, cotinine is considered a promising biomarker of smoking exposure.
Ø The use of cotinine also has its limitations. Cotinine level is a reflection of smoking over the past few days. This may be misleading if the patient is smoking on weekends or if the patient was smoking less due to a period of illness.
Ø The second limitation lies in its inability to differentiate between never-smoking and former-smoking
Ø the level of evidence provided by this article: 1
Ø How do you help renal transplant patients to stop smoking:
Work up:
Cardiac evaluation
Vascular tree
Chest x-ray
PFT
CPET
Treatment: smoking cessation program and chest physiotherapy
ü What is the effect of smoking on kidney donors:
· Increase in arginine vasopressin levels
· Increase serum epinephrine
· Increase in renal vascular resistance by 11%
· Decrease in the glomerular filtration rate (GFR) by 15%.
Mahmoud Wadi
2 years ago
V. Smoking in Renal Transplantation; Facts Beyond Myth
Briefly summarise this article
What is the level of evidence provided by this article?
How do you help renal transplant patients to stop smoking?
What is the effect of smoking on kidney donors?
Briefly summarise this article INTRODUCTION
– Smoking have a well-known correlation with CV diseases, pulmonary diseases, malignancy and death.
– Also may have a role in atherosclerosis, endothelial dysfunction, progression of vascular disease progression of proteinuria.
– This makes smoking a significant renal risk factor.
– Immune suppression medications aggravate the effect of smoking
**There are few studies for the effect of smoking on kidney transplant. Pinto-Sietsma et al perform a study to evaluate the effect of smoking on the development of albuminuria and abnormal kidney functions in non-diabetic population.
**There was a dose-dependent association between smoking and development of both microalbuminuria
**This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers.
Aim of the study: explore the effect of smoking on renal transplantation especially with smoking biomarker
Key words: Smoking; kidney donor; kidney recipient; Renal transplantation
EFFECTS OF SMOKING ON THE KIDNEY
-Ritz et al studied the effect of smoking on healthy normotensive volunteers.
-They reported a significant increase in arginine vasopressin levels and serum epinephrine.
-There was an increase in renal vascular resistance by 11% and a decrease in the GFR by 15%.
-They assumed these effects are secondary to nicotine itself as these findings were reproduced by using nicotine containing gum.
RECIPIENT SMOKING AND TRANSPLANTATION OUTCOME
-Smoking is a well-known risk factor for CV disease.
-The development of de novo cardiovascular insult in the first year post-transplant was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and duration of dialysis.
There is a clear association between smoking and increased risk for certain types of malignancy
– Most studies have revealed a clear benefit of smoking cessation on graft survival, but the effect on patient survival is less clear
EFFECT OF SMOKING HABIT OF KIDNEY DONOR ON THE OUTCOME Of TRANSPLANTATION
-Donor smoking also affect the recipient survival years after transplantation.
Lin et al have analysed data from the United Network for Organ Sharing from 1994 to 1999, and they declared that smoking habit of the donor has mild, yet statistically significant effect on recipient survival
Smoking biomarker and renal transplant
-A proper estimation of the risks associated with tobacco use depends on accurate measurement of exposure.
-Self-reporting estimation lacks accuracy (Some patients may not recall the number of cigarettes accurately; tobacco dose differs between individuals due to the difference between cigarettes).
-So development of a valid and accurate biomarker for tobacco smoking is importance
-Cotinine is the major metabolite of nicotine. It has a relatively constant level due its long half-life (16 h vs 2-3 h for nicotine), can be measured in plasma or urine.
– For these reasons, cotinine is considered a promising biomarker of smoking exposure.
**Hellemons et al studied 603 renal transplant recipients to investigate the relation of self-reporting and cotinine exposure and to evaluate the use of cotinine as an alternative for self- report.
-They concluded that active smoking had a negative impact on patient and graft survival, while former smokers had increased the risk of mortality but not graft failure.
– They documented that cotinine measurement (especially plasma cotinine) provides a valid alternative to self-reported smoking exposure, and it may even be preferred over self-reporting in epidemiological studies.
**Limitations of cotinine level: is a reflection of smoking over the past few days, and this may be misleading if the patient is smoking occasionally (like in weekends) or if the patient was smoking less due to a period of illness.
-The second limitation lies in its inability to differentiate between never-smoking and former-smoking.
-Differentiating never-smoking from former-smoking is clinically relevant as former-smoking was proved to be associated with increasing risk of recipient mortality
Combination of cotinine measurement and self-reporting of smoking exposure will be the most reliable approach in evaluating renal transplant population.
CONCLUSION
The use of smoking biomarkers proved to be reliable in evaluation and quantification of smoking exposure in the transplant population.
Donor smoking and recipient former smoking proved to have a negative impact on survival.
Transplant community should pay more attention to donor and recipient smoking cessation programs.
What is the level of evidence provided by this article?
The level of evidence V
How do you help renal transplant patients to stop smoking? SMOKING CESSATION PROGRAMME : –
Offer a pluridisciplinary team, including doctors, nurses, social workers, psychologists and dieticians, who have access to drugs and medical facilities
First approach of SCPs is usually non-pharmaceutical, using behavioural, motivational and cognitive interviewing of the patient (counselling)
The 5As (ask, assess, advise, assist, and arrange follow-up) is the gold standard intervention and is efficient to increase the quitting rate
Ask: Systematically identify the smoking status at every visit
Advice: Provide a very brief, non-threatening recommendations to quit
Assess: Evaluate if the patient is ready to stop
Assist: Offer practical help for quitting
Arrange: Ensure the follow-up of the patient
What is the effect of smoking on kidney donors?
*Kidney donor smoking history negatively affects perioperative renal function
*Smoking history is associated with development of CKD after donation
*Longer pack-year history is associated with CKD, even in former smokers
*Smoking-cessation strategies should be implemented.
Sahar elkharraz
2 years ago
Many studies shows associated of smoking with CVD / pulmonary disease/ malignancy and death.
Smoking has role in atherosclerosis/ endothelial dysfunction/ progressive of vascular disease and progressive proteinuria.
Effects of smoking in renal transplant increase chance of carcinogenic in presence of immunosuppressive therapy and doubling risk of cardiovascular disease.
Effects of smoking in kidney:
Many studies shows progressive of intrinsic renal disease like diabetic nephropathy/ IgA nephropathy and ADPKD.
By using smoking shows increase of arginine vasopressin level and serum epinephrine and increase renal vascular resistance and decline of eGFR.
Recipient smoking and transplant outcome:
Smoking is well known risk factors of CVD.
Cardiovascular disease is leading cause of death in kidney transplant.
Development of de novo CVD is associated with old age/ pre transplant hypertension/ smoking and duration of dialysis.
Second leading cause of death post transplant was malignancy.
Current smoking has increase incidence of vascular intimal fibrous thickening.
Degree of chronic sclerosing nephropathy and arteriolar hyalinosis associated with duration of time post transplant.
Many studies shows effects of cessation of smoking on graft survival but patients survival is less obvious.
Effects of smoking habits of kidney donor on outcome of transplant.
Donor smoking also has effects on kidney transplant survival.
Smoking biomarker and renal transplant.
Cotinine is a bio markers of smoking exposure reliable in evaluation and quantity.
Limitations of cotinine is giving smoking exposure in past 5 days only.
It’s difficult to differentiate between never smoking and former smoking.
Combination of cotinine measurements is self reporting of smoking exposure.
It’s reliable approaches in evaluation renal transplant populations.
conclusion:
Smoking has adverse effects on recipient kidney transplant and smoking donor kidney reduce graft survival.
Risk of mortality increase in old age and DM, HTN and smoking.
Smoking cessation before transplant has improve graft survival and patients survival and reduce rate of malignancy.
Transplant community should be pay attention on donor and recipient for smoking cessation program.
What is the level of evidence provided by this article?
Level V
How do you help renal transplant patients to stop smoking?
By counselling for smoking cessation program /evaluation of nicotinine in plasma and nicotine replacement therapy
What is the effect of smoking on kidney donors?
Its increase graft loss in recipient transplant and associated with increase risk of cardiovascular disease and risk of malignancy
Khadija Alshehabi
2 years ago
Briefly summarise this article
Smoking is a challenging health care problem; it has a well-established correlation with many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death. It is also identified as a significant renal risk.
The effect of smoking is aggravated in renal transplant recipients due to the effect of immune suppression medications on carcinogenesis, in addition to the effect of chronic kidney disease itself on cardiovascular risk and mortality.
Effects of smoking on the kidney
Many studies confirmed the role played by smoking in the progression of many intrinsic renal diseases (e.g., diabetic nephropathy, IgA nephropathy and autosomal dominant polycystic kidney disease).
A study by Ritz et al. showed increase in renal vascular resistance by 11% and a decrease in the glomerular filtration rate (GFR) by 15%. They assumed these effects are secondary to nicotine itself as these findings were reproduced by using nicotine containing gum. Another cross-sectional study by Pinto-Sietsma et al documented the presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment in this screening. These findings were less obvious or absent in former smokers.
Recipient smoking and transplantation outcome
Ponticelli et al have addressed the role of cardiovascular disease as the leading cause of death in renal transplant recipient. The development of de novo cardiovascular insult in the first-year post-transplant was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and duration of dialysis.
The second leading cause of death post-transplantation was malignancy with a clear association between smoking and increased risk for certain types of malignancy.
Several retrospective studies demonstrated the negative impact of smoking on graft survival as a well as patient’s survival and that smoking cessation has a clear benefit on graft survival.
Effect of smoking habit of kidney donor on the outcome of transplantation
Lin et al. found that smoking habit of the donor has mild, yet statistically significant effect on recipient survival. Another retrospective study found that the effect of donor smoking on graft survival was statistically insignificant, unlike the recipient smoking which proved to be significant. However, the recipient survival was negatively correlated to donor smoking and recipient smoking. Heldt et al found that the recipients of smoking donors had lower calculated GFR with a mean follow up of 38 months.
Smoking biomarker and renal transplantation
Self-reporting of smoking exposure has certain limitations; thus, it is important to search for a valid and accurate biomarker for tobacco smoking.
Cotinine is the major metabolite of nicotine. It has a relatively constant level due its long half-life (16 h vs 2-3 h for nicotine), which can be measured in plasma or urine. For these reasons, cotinine is considered a promising biomarker of smoking exposure.
Hellemons et al documented that cotinine measurement (especially plasma cotinine) provides a valid alternative to self-reported smoking exposure, and it may even be preferred over self-reporting in epidemiological studies. However, the use of cotinine also has its limitations. Cotinine level is a reflection of smoking over the past few days, and this may be misleading if the patient is smoking occasionally. It is also unable to differentiate between never-smoking and former-smoking. Therefore, a combination of cotinine measurement and self-reporting of smoking exposure could be the most reliable approach in evaluating renal transplant population.
What is the level of evidence provided by this article?
Level V. Evidence from systematic reviews of descriptive and qualitative studies (meta-synthesis).
How do you help renal transplant patients to stop smoking?
By smoking counselling and smoking cessation programs or application of Nicotine replacement therapy (NRT), Bupropion, Nicotinic cholinergic receptor partial agonist: varenicline and cytisine.
What is the effect of smoking on kidney donors?
Cigarette smoking in kidney donors is associated with higher rate of perioperative complications and postoperative wound infections. These donors are less likely to provide follow-up information requested by transplant centers [26]. There are mixed results for impact on graft function.
Reference:
Khalil MAM, Tan J, Khamis S, Khalil MA, Azmat R, Ullah AR. Cigarette Smoking and Its Hazards in Kidney Transplantation. Adv Med. 2017;2017:6213814. doi: 10.1155/2017/6213814. Epub 2017 Jul 27. PMID: 28819637; PMCID: PMC5551477.
Donors with a smoking history require close observation due to increased risk of CKD development after kidney donation.
Reference:
Y.E. Yoon, H.H. Lee, J.C. Na, K.H. Huh, M.S. Kim, S.I. Kim, Y.S. Kim, W.K. Han,Impact of Cigarette Smoking on Living Kidney Donors,Transplantation Proceedings, Volume 50, Issue 4, 2018, Pages 1029-1033, ISSN 0041-1345, https://doi.org/10.1016/j.transproceed.2018.02.050.
Kauffman-Ortega C, Martínez-Delgado GH, Garza-Gangemi AM, Oropeza-Aguilar M, Gabilondo-Pliego B, Gabilondo-Navarro F, Rodríguez-Covarrubias F. Short-and Mid-Term Impact of Tobacco Smoking on Donor Renal Function Following Living Kidney Donation at a Tertiary Referral Hospital. Revista de investigación clínica. 2021 Aug;73(4):238-44.
Tahani Ashmaig
2 years ago
Summary:
Smoking in Renal Transplantation; Facts Beyond Myth Introduction The effect of smoking is more obvious on the renal allograft most probably due to the chronic immune suppression status and the metabolic effect of the drugs. In addition to the effect of CKD itself on cardiovascular risk and mortality.
Effeccts of smoking on the kidney: – Many studies confrmed the role played by smoking in the progression of many intrinsic renal diseases. – Smoking increase renal vascular resistance and decrease GFR – Presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment was documented. Recipient smoking and transplantation outcome – Smoking is associated with lowering patient and graft survival. – Even receiving a renal transplant from a smoker donor increases the risk of death for the recipient and carries a poorer graft survival compared to non-smoking donors. – Smoking is correlated to fatal outcomes which are aggravated in solid organ transplant recrecipients. – Most of studies have revealed a clear beneft of smoking cessation on graft survival, but the effect on patient survival is less clear possibly reflecting the permanent atherosclerotic effect on the vascular system. Effect of smoking habit of kidney donor on the outcome of transplantation The donor smoking will not affect graft survival but it can affect the recipient survival years after transplantation. Smoking biomarker and renal transplantation – Cotinine which is the major metabolite of nicotine is a promising biomarker of smoking exposure. – Combination of cotinine measurement and self-reporting of smoking exposure is the most reliable approach in evaluating renal transplant population.
▪︎What is the level of evidence provided by this article? Level 5
▪︎How do you help renal transplant patients to stop smoking?
I will consult him about the adverse effects of smoking on graft survival and patient mortality and the importance of smoking cessation, and I will send him to a psychologist to help him to stop smoking. ▪︎What is the effect of smoking on kidney donors?
Smoking in kidney donors is associated with higher rate of perioperative complications and post operative wound infection.
Huda Saadeddin
2 years ago
Smoking is one of the preventable leading causes of death worldwide.
Smoking is a challenging health care problem; it has a well-established correlation with many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death
There are emerging evidence correlating tobacco use with pathological changes in the normal kidneys. The effect is more obvious on the renal allograft most probably due to the chronic immune suppression status and the metabolic effect of the drugs.
Cigarette smoking assumes to have a role in atherosclerosis, endothelial dysfunction, progression of vascular disease progression of proteinuria, as it contains large amounts of free radicals. This makes smoking a significant renal risk factor, with considerable consequences on health care budget.
Studies documented the presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment
Most of these studies have revealed a clear benefit of smoking cessation on graft survival, but the effect on patient survival is less clear possibly reflecting the permanent atherosclerotic effect on the vascular system.
One of the studies shows that Smoking was associated with
more often vascular fibrous intimal thickening in smokers compared to non-smokers so that it may have a role in the development of chronic allograft nephropathy and graft loss.
History of smoking will negatively
affect patient and graft survival. Also, it increases the risk of early rejection
However, the recipient survival was negatively correlated to donor smoking and recipient smoking
Cotinine is the major metabolite of nicotine. It has a relatively constant level due its long half-life (16 h vs 2-3 h for nicotine), which can be measured in plasma or urine.
We believe that the combination of cotinine measurement and self-reporting of smoking exposure will be the most reliable approach in evaluating renal transplant population.
CONClUsION
Smoking remains a major modifiable health care challenge; it is the leading cause of variable morbidities and mortality. The use of smoking biomarkers proved to be reliable in evaluation and quantification of smoking exposure in the transplant population. Donor smoking and recipient former smoking proved to have a negative impact on survival. Transplant community should pay more attention to donor and recipient smoking cessation programs.
What is the level of evidence provided by this article?
Level V
How do you help renal transplant patients to stop smoking?
Patient education about disadvantages and side effect of smoking
Psychiatrist help and referral to smoking session program
using nicotine containing gum and other modalities that help in smoking sensation
On donor it will affect on his cardiovascular system,respiratory
Mu'taz Saleh
2 years ago
Briefly summarise this article:
as all of us knows smoker is one of the most important risk factor for CVD , Respiratory disease , Infection , malignancy , on the other hand transplantation and suppression medication increase all the mentioned risk factor so the transplantation with smoking associated with high rate of mortality and morbidity and negative impact on allograft survival .
smoking can affect renal system by many mechanism
worsening of protinurea
increase in arginine vasopressin and serum epinephrin levels, leads to increased renal vascular resistance and reduce GFR
rapid progression of certain renal disease IgAN , DNP , ADPKD
the effect on renal transplantation
The studies show clear benefit of cessation on graft survival but not patient survival.
In smoker donors some studies highlights deleterious effect in recipient survival, decreased GFR post transplant, and graft survival as well.
Cotinine is a nicotine metabolite with log half life of 16 hrs, a biomarker of smoking exposure, measured in plasma and urine, used in many studies and assures the negative effect of active smoking on patient and graft survival, and ex-smoking had increased risk of mortality but not affect graft survival. Cons of this biomarker is it could be high in occasional smokers, passive smokers , cannot differentiate never smoke and former smoker, so detailed smoking history and this biomarker can be a reliable approach in evaluating renal transplant population
What is the level of evidence provided by this article?
level of evidence V
How do you help renal transplant patients to stop smoking?
we discus with patient the adverse effect of smoking and the benefit of smoking session on his general health and allograft survival
refer him to smoking session program
What is the effect of smoking on kidney donors?
increase peri operative complication ( poor wound healing , high risk of pnemothorax , chest infection , atelactesis )
high risk of CV adverse effect
increase risk of kidney injury .
Abdul Rahim Khan
2 years ago
Briefly summarise this article
Smoking is associated with increased risk of cardiovascular disease, pulmonary pathologies and higher cancer risks. This increases the morbidity and mortality.
It has now been proved that smoking has significant effects on renal graft and can affect graft outcomes.
Stopping smoking before transplant is recommended and may improve overall outcomes. The effect on graft can be due to chronic immune suppression. EX smokers ay have greater mortality but not much effect on graft.
Overall it has negative impact on graft as it can lead to endothelia injury, atherosclerosis, progression of vascular insult and proteinuria.
Smoking increases vascular resistance and decreases GFR. It can increase microalbuminuria and can cause progression of hematuria.
Cotinine can be used as a marker of smoking status exposure to nicotine.
Effects on renal transplant recipient are significant and include.
Microalbuminuria and development of renal failure
Increased vascular resistance
Decreased GFR
Progression diabetic or IgA nephropathy
Higher risk of malignancy
Increased risk of CVD and pulmonary disease
What is the level of evidence provided by this article?
Level V review article
How do you help renal transplant patients to stop smoking?
Patient education and counselling
Use nicotine gums and patches
Referral to smoking cessation programme
What is the effect of smoking on kidney donors?
High risk of peri operative complications
High risk of respiratory complications
High risk f wound dehiscence
Secondary polycythemia.
Abdulrahman Ishag
2 years ago
Briefly summarise this article
Smoking is associated with serious medical conditions like;
– cardiovascular diseases
-pulmonary diseases
-malignancy
-death.
Smoking has a significant renal risk factor, with considerable consequences on health care budget and this may be due to;
– its role in atherosclerosis
– It causes endothelial dysfunction
– Its role in progression of proteinuria .
There are emerging evidence correlating tobacco use with pathological changes in
the normal kidneys.
Many studies confirmed the role played by smoking in the progression of many intrinsic renal diseases (e.g., diabetic nephropathy, IgA nephropathy and autosomal
dominant polycystic kidney disease).
The effect is more obvious on the renal allograft most probably due to the chronic immune suppression status and the metabolic effect of the drugs.
Cotinine was proposed as a promising biomarker that may help to provide objective evidence regarding the status of smoking and the dose of nicotine exposure, yet there are still some limitations of its use.
Recipient smoking and transplantation outcome ;
Smoking is strongly correlated to some of the potentially fatal outcomes, and there is some evidence that these complications are aggravated in solid organ transplant
recipients.
.
Smoking is a well-known risk factor for cardiovascular disease.
The development of de novo cardiovascular insult in the first year post-transplant
was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and duration of dialysis.
The second leading cause of death post-transplantation was malignancy
with a clear association between smoking and increased risk for certain types of
malignancy.
.
Most of these studies have revealed a clear benefit of smoking cessation on graft survival, but the effect on patient survival is less clear possibly reflecting the permanent atherosclerotic effect on the vascular system.
It may be logic that the recipient smoking will affect his own survival, but surprisingly, even the donor smoking will affect the recipient survival years after transplantation.
Several studies have documented a deleterious effect of smoking on the renal transplant recipients.
Smoking was associated with lowering patient and graft survival. Smoking cessation proved to improve graft survival and to a lesser extent recipient survival.
Even receiving a renal transplant from a smoker donor increases the risk of death for the recipient and carries a poorer graft survival compared to non-smoking donors.
What is the level of evidence provided by this article?
Level V
How do you help renal transplant patients to stop smoking?
1-The smoking status of every KT candidate or recipient should be assessed at every appointment.
2-An SCP is offered to every smoking patient.
The first approach of SCPs is usually non-pharmaceutical, using behavioural, motivational and cognitive interviewing of the patient (counselling).
Then a pharmaceutical approach is generally proposed and must be adapted to the patient’s medical history and expectations.
What is the effect of smoking on kidney donors?
Lin et al declared that ,smoking habit of the donor has mild, yet statistically significant effect on recipient survival .
Underwood et al studied a retrospective analysis of 602 kidney transplant recipients and their living donors .The effect of donor smoking on graft survival was statistically insignificant . Unlike the recipient smoking which proved to be significant. The recipient survival was negatively correlated to donor smoking.
Heldt et al evaluated GFR of 100 living donors and their recipients, found that ,the recipients of smoking donors had lower calculated GFR .
.
KAMAL ELGORASHI
2 years ago
Smoking is the one of the preventable leading cause of death worldwide, many studies focus on smoking effect on cardiovascular , chest, malignancy and death .
In general , effect of smoking on kidney, involve its effect on vascular system (atherosclerosis), endothelial dysfunction, progression of vascular disease, and proteinurea, as the effects of free radicals, those effects additionally augmented in transplat recipient by effect on immunosuupressant medications, and effect of CKD on cardiovascular risk of mortality.
Effect of smoking on kidneys: Ritz et al. ;
study show the effect of smoking on health normotensive volunteers, show that increase arginine vasopression, level from ( 1.27 +/- 0.72 to 19.9+/-27.2), and increase in epinephrine level from (37+/-13 to 140) , and increase in vascular resistance by 11%, and decrease in GFR by 15%, all as a result on nicotine.
Pinto–Sietsma et al. :
cross-sectional study, involve 7476 participants, study the effect of smoking in microalbuminurea, and abnormal renal function, in non-diabetic population.
they document the presence of dose dependant association between smoking and development of both micro albuminurea, and renal impairment, these finding were less obvious in former smokers.
Recipient smoking and kidney transplant outcome;
Smoking are well known risk factor for development of cardiovascular disease.
Ponticelli et al. ; adressed the role of CVD as a leading cause of death in transplant recipients, also development of Denovo cardiovascular insult in the first year post-transplant, and association between pre-transplnt CVD, older age, pre-existing HTN, smoking, and duration of dialysis.
The second leading cause of death post transplant is malignancy and the association between malignancy and smokin.
Zitt et al.:
study realtion between smoking and renal biopsy, for 76 transplant kidneys , found that current smoker have increase severity of vascular imtimal fibrosis thickness with P value of 0.004.
The following studies show that the effects of smoking on kidney transplant;
Arend et al.; done on 1997, retrospective study, total patients 016 with 394 are smokers, conclude that,RR2.2 of mortality after 1 year of transplant, with the risk of mortality were higher in older age , men , DM , HTN and smokers.
Cosio et al.; done on 1999 with total of 523 patients and 147 are smoker, found that survival are shorter in smokers, and history of smokong correlates to decrease patients survival due to effect of smoking, and the effect of smoking is quantitatively equall to the effect of DM .
Kasiske et al.; 12done on 2000 with participants including smokers, 1334/330, RR1.3of graft loss. with smoking more than 25 peak /year, increase risk of death, RR1.42. RR 8.1 graft loss. RR 7.9 mortality.
Doyle et al.; done on 2000 with participants including smoker 206/155.found that RR8.1 for graft loss, RR7.9 for mortality, and conclude that tobacco associates with worse patient graft survival,compared with non-smoker, or quiet smoking at least 2 month before transplant.
Matas et al.; done on 2001 on 2540 no smoker shared mentioned, found that renal Tx smoker has RR 2.1 graft loss , and conclude that post Tx ,PVD, or dialysis > 1 year associate with worse long term outcome.
Sung et al.; done on 2001 involve 645/156 with RR2.3 graft loss.and conclude taht graft survival in smoker versus non-smoker was(84% v 88%) at 1st yrs post Tx. and (65% v 78%) at 5 yrs, and (48% V 88%) at 10 yrs with significant P value (0.007).
Yavuz et al.; done on 2004 with participant including smoker 226/97 , found no significant relation between pre Tx smoker and graft loss or mortality , conclude that significant effect of smoking may be limited due to limited number of patient .
Kheradmond et al.; done on 2005, involve 199/41 participants, found that preTx smoker associated with decrease overall graft loss, and conclude that smoking associates with incraese graft loss, but no realtion with rejection episodes.
Gombos et al.; done on 2010 particpants 402/102 found that significant renal failure after 3 yrs . and conclude that graft faliure coorelates with intensity of smoking
Nogueira et al.; done on 2010, with 997/329 patients , found that smoking affects patient and graft survival,and GFR lower in smoker 1 yr after Tx with little risk of graft rejection.
Hurst et al.; done on 2011 involve 41705/5832 patients, found that new onset smoker has incresae risk of graft failure and death , compared to non-smoker , and conclude that new onset smoker associates with lower patient and graft survival.
Agarwal et al.; done on 2001 , 604/133, found that , current smoker has increased risk of graft failure and death, compared with non-smoker, and pst smoker associates with similar graft failure compared with non-smoker . conclude that current smoker has increase risk of graft failure and mortality, despite smoking cessation may not alter risk of motrtality, but at least improved graft survival.
Opels et al.; done on 2016 involve 46548/15086, whose quiet smoking before Tx , show clear benifit of graft survival, compared with patient continue smoking, and conclude improve all cause graft survival all cause mortality and death , and smoking cessation decrease malignancy compared smoker , and decrease malignancy courance of respiraory,urinary, female genital organ , oral and lip malignancy.
Conclusion ;
smoking is the major modifiable health care challenge, and a leading cause of variable comorbidities and mortality.
we can help potentail recipient to stop smoking by proper councelling about the risk of smoking with detailed mensioned in this article, and also reffer him to smoking clinic, who design program for such patients.
Heba Wagdy
2 years ago
Smoking is a risk factor for CVD, pulmonary disease, malignancy and death. It has a negative impact on kidney function. Kidney transplant recipients are at more risk due to the use of immunosuppressants with its carcinogenic effect and CKD itself which is a risk factor for CVD.
Data about the effect of smoking on kidney transplant population is insufficient. Effect of smoking on the kidney:
It accelerate the progression of many renal diseases as diabetic nephropathy, IgA nephropathy and ADPKD
It increase renal vascular resistance and decrease GFR in healthy people and was associated with development of microalbuminuria and impaired kidney function during screening in non-diabetic population Recipient smoking and transplant outcome:
The adverse effects of smoking are more prominent in transplant patients.
Smoking is one of the main risk factors for CVD, the leading cause of death in kidney transplant recipients.
It is associated with increased risk of certain malignancies, the second leading cause of death post transplant.
A study showed that kidney recipients who were current smokers had more severe vascular intimal fibrous thickening than nonsmokers.
Several studies showed that cessation of smoking improved graft survival but had no effect on patient survival mostly due to the permanent atherosclerotic effect of smoking. Effect of smoking habit of donor on outcome of transplant:
Donor smoking affects recipient survival even years post transplant.
A study showed that smoking habit of donor had a mild but significant effect on recipient and graft survival.
Other retrospective study showed insignificant effect on graft survival but with negative correlation between recipient survival and donor smoking
Recipients of smoking donors had lower GFR during follow up. Smoking biomarker and renal transplantation:
Accurate analysis of dose of smoking is difficult as it depends on self reporting which may be misleading due to social causes, may not be recalled accurately, different tobacco doses in different cigarettes and different inhaling habits.
Cotinine is a promising biomarker of smoking exposure, can be measured in plasma or urine.
It can be used as alternative to self reported smoking exposure and is preferred in epidemiological studies.
It has some limitations as it reflects smoking over past days only and can’t differentiate between never smoking and former smoking, former smoking is associated with increased risk of recipient mortality.
Combination of cotinine level and self reporting of smoking is the most reliable approach to evaluate kidney transplant population.
What is the level of evidence provided by this article?
Level 5, review article
How do you help renal transplant patients to stop smoking?
Counselling them about the risks of smoking and its adverse effects.
encouraging them to join smoking cessation programs.
What is the effect of smoking on kidney donors
Kidney donors who smoke have higher rate of perioperative complications and are at increased risk of wound and chest infections.(1)
Donors who actively smoke or were former smokers had higher serum creatinine than non smokers one year after donation.(1)
Amsterdam Forum guidelines recommend cessation of smoking 6 weeks before kidney donation.(1)
(1)Khalil MA, Tan J, Khamis S, Khalil MA, Azmat R, Ullah AR. Cigarette smoking and its hazards in kidney transplantation. Advances in Medicine. 2017 Jul 27;2017.
Summary of the article
-Smoking causes diffuse endothelial injury, causing vascular diseases all over the body and can rapidly progress the diabetic nephropathy and IgA nephropathy as well as causing arterial hylainosis and chronic sclerosing nephropathy in the kidney graft.
-Regarding the renal allograft, Smoking may acutely reduce the eGFR by up to 10-15% and may lead to rapid progression of proteinuria, diabetic nephropathy, as well as reduced renal blood flow.
-Ways that aid in quitting smoking include counseling and group sessions hand in hand with pharmacological agents entailing nicotinic cholinergic receptor partial agonist and Bupropion.
This is a review article of level 5 evidence.
Smoking was associated with lowering patient and graft survival. Cotinine is considered a promising biomarker of smoking exposure. However, the use of cotinine also has its limitations as Cotinine level is a reflection of smoking over the past few days, and this may be misleading if the patient is smoking occasionally. The second limitation lies in its inability to differentiate between never-smoking and former-smoking. Thus, the combination of cotinine measurement and self-reporting of smoking exposure will be the most reliable approach in evaluating renal transplant population. Donor smoking and recipient former smoking proved to have a negative impact on survival. Transplant community should pay more attention to donor and recipient smoking cessation programs.
level 5 evidence
This study discuss the effect of smoking on patient with ckd , kidney transplant recipient and donor, it had a bad effect of kidney disease like diabetic nephropathy,IgA and APKD it increase their progression also it decrease the graft survival as well.
it is a level 5 evidence .
we can help the renal transplant recipient to stop smoking by counselling about the risk of losing the graft and help them by increasing the physical activity.
the effect of the smoking on the donor as it decrease the GFR in the donate kidney and made them liable to cardiovascular disease
Briefly summarise this article
INTRODUCTION : Smoking is a challenging health care problem; it has a well-established correlation with many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death. Cigarette smoking assumes to be responsible for atherosclerosis, endothelial dysfunction, progression of vascular disease progression of proteinuria, as it contains large amounts of free radicals.
This makes smoking a significant renal risk factor, with considerable consequences on health care budget. The effect of smoking is aggravated in renal transplant recipients due to
· Effect of immune suppression medications on carcinogenesis
· Effect of chronic kidney disease itself on cardiovascular risk and mortality
Effects of smoking on the kidney
smoking may lead to progression of many intrinsic renal diseases (e.g., diabetic nephropathy, IgA nephropathy and autosomal dominant polycystic kidney disease).
Ritz et al. studied the effect of smoking on healthy normotensive volunteers.
· They reported a significant increase in arginine vasopressin levels and serum epinephrine
· increase in renal vascular resistance by 11%
· decrease in the glomerular filtration rate (GFR) by 15%.
· They assumed these effects are secondary to nicotine itself as these findings were reproduced by using nicotine containing gum.
Pinto-Sietsma et al. They documented
· the presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment in this screening.
· These findings were less obvious or absent in former smokers
Recipient smoking and transplantation outcome
Smoking associated with fatal outcomes, these complications are aggravated in solid organ transplant recipients.
Smoking is a well-known risk factor for cardiovascular disease.
It is associated with malignancy which is the 2nd cause of death post-transplantation
The effect of smoking on renal transplant recipients was investigated in several studies , one of them revealed that, current smokers had an increase in the severity of vascular intimal fibrous thickening.
While, most of these studies have revealed a clear benefit of smoking cessation on graft survival.
but the effect on patient survival is less clear.
Effect of smoking habit of kidney donor on the outcome of transplantation :
Studies reported the following:
1. It may be logic that the recipient smoking will affect his own survival, but surprisingly, even the donor smoking will affect the recipient survival years after transplantation.
2. The effect of donor smoking on graft survival was statistically insignificant . Unlike the recipient smoking which proved to be significant .
3. the recipients of smoking donors had lower calculated GFR
Smoking biomarker and renal transplantation
A proper estimation of the risks associated with tobacco use depends on accurate measurement of exposure, which may be difficult in certain population such as pregnant women and parents of young children, where smoking considered socially unaccepted.
Some patients may not recall the number of cigarettes accurately (digit bias). and finally the tobacco dose differs between individuals due to the difference between cigarettes as well as the difference in inhaling habits (passive smoking.
All these factors made the development of a valid and accurate biomarker for tobacco smoking of ultimate importance.
Cotinine is the major metabolite of nicotine. It has a relatively constant level due its long half-life (16 h vs 2-3 h for nicotine), which can be measured in plasma or urine.
For these reasons, cotinine is considered a promising biomarker of smoking exposure
Hellemons et al reported using the above biomarker that active smoking had a negative impact on patient and graft survival, while former smokers had increased the risk of mortality but not graft failure.
The use of cotinine also has its limitations.
· Cotinine level is a reflection of smoking over the past few days, and this may be misleading if the patient is smoking occasionally .
· The second limitation lies in its inability to differentiate between never-smoking and former-smoking.
Conclusion
· Smoking remains a major modifiable health care challenge; it is the leading cause of variable morbidities and mortality.
· The use of smoking biomarkers proved to be reliable in evaluation and quantification of smoking exposure in the transplant population.
· Donor smoking and recipient former smoking proved to have a negative impact on survival.
· Transplant community should pay more attention to donor and recipient smoking cessation programs.
What is the level of evidence provided by this article?
5
How do you help renal transplant patients to stop smoking?
Psychological support, advising to join programs to quit smoking , medications which helps to stop smoking .
What is the effect of smoking on kidney donors?
Increasing risk of anesthesia , risk of hypertension, risk of ckd, risk of chest infection. and most importantly risk of cardiovascular disease.
death rate among kidney donors who were smokers significantly higher than non smoker and they were found to have higher serum creatinine at end of 1 year as compared to nonsmokers.
1) Summary
Smoking is a very common worldwide prevalent risk factor for several CV, pulmonary and malignant conditions. Smoking also has its hazardous impact on normal kidney that become more severe on kidney graft due chronic immunosuppressive status and the metabolic derangement caused by immunosuppressive drugs, where poorer recipient and graft survival were encountered in smokers compared to nonsmoker recipients and even graft from smoker donor has lower survival rate compared with nonsmoker donor.
CV effects of smoking include exaggerated atherosclerosis, endothelial dysfunction, increase vascular resistance, hormonal disturbance as increase secretion of epinephrine and arginine vasopressin.
On the kidney, smoking produce dose dependent albuminuria and decrease in GFR.
On kidney recipients, smoking leads to poor patient survival as it increases the risk of CV diseases and malignancy that are the leading causes for death among kidney recipients.
Smoking causes variable, severe pathological changes in kidney graft that shortens the graft survival as chronic glomerular sclerosis and arterial hyalinosis.
Studies evaluating the impact of smoking on kidney recipients and graft survival had several limitations as most studies depend on self-reported questionnaire as till now no well-known marker to reflect severity of smoking status is available. A new biomarker, cotinine, the end metabolite of nicotine has been currently investigated but it also has its limitation as it reflects smoking status during the last few days so not accurate if the patient was an occasional smoker or stopped smoking recently.
Active smoking was associated with increased graft loss and patient death while former smoking was associated with increased recipient death but not graft loss.
2) level of evidence :5
3) How to help the patient to stop smoking
a) Counselling the smokers regarding hazardous effects of smoking.
b) Motivation and phycological support.
c) Pharmacological interventions to help nicotine withdrawal via electronic cigarettes, nicotine replacement programs with Bupropion and nicotinic cholinergic receptor agonist.
4) Effect of smoking on kidney donor:
as smoking is associated with increased CV morbidity and mortality risk, premature atherosclerosis which in turn increase the risk of CKD after kidney donation.
Effects of smoking on the kidney
1.Smoking plays a role in the progression of many intrinsic renal disease as DN, IgA nephropathy and APKD
2.Smoking leads to increase renal vascular resistance and decrease in GFR, these effects are secondary to nicotine itself.
3.There is a dose dependent association between smoking and development of both microalbuminuria and renal impairment.
Effect of recipient smoking and transplant outcomes
1.Cardiovascular disease is leading cause of death in renal recipients.The development of denovo cardiovascular insult in the first year post-transplant was associated with smoking , pre-existing cardiovascular disease,HTN, older age and duration of dialysis.
2.Malignancy is the second leading of death after transplantation there is a clear relation between smoking and malignancy.
3.Increase in the severity of vascular intimal fibrous thickening on renal biopsy of kidney recipients.
Effect of smoking habit of kidney donor on the outcome of transplantation
1.Donar smoking will affect the recipient survival years after transplantation.
2.The recipients of smoking donors had lower calculated GFR.
Smoking biomarker and renal transplantation
Evaluation of renal transplant population should be done by combination of cotinine measurement and self reporting of smoking exposure.
Question 2
level of evidence 5
Question 3
How do you help renal transplant patients to stop smoking?
Through smoking cessation programs
first approach is non-pharmaceutical, using motivational and cognitive interviewing of the patient (counselling).
A pharmaceutical approach must be adapted the patient medical history and expectations.
Nicotine replacement therapy , Bupropion, Nicotinic cholinergic receptor partial agonist and electronic cigarette.
Question 4
Effect of smoking in kidney donor
Donors with a smoking history have increased risk for development of CKD after kidney donation.
.
Effects of smoking on the kidney
Smoking has a role in the progression of many intrinsic renal diseases (e.g., diabetic nephropathy, IgA nephropathy and autosomal dominant polycystic kidney disease)
Smoking can affect healthy kidneys in form of increase in arginine vasopressin levels ( and serum epinephrine with an increase in renal vascular resistance and a decrease in the glomerular filtration rate. Smoking was associated with the development of albuminuria and abnormal kidney functions in non-diabetic population in a dose-dependent association manner.
Recipient smoking and transplantation outcome
1. cardiovascular disease. : de novo cardiovascular insult in the first year post-transplant
2. malignancy
3. renal biopsy : increase in the severity of vascular intimal fibrous thickening , chronic sclerosing nephropathy and arteriolar hyalinosis
Effect of smoking habit of kidney donor on the outcome of transplantation
donor smoking will affect the recipient survival years after transplantation and graft survival.
Smoking biomarker and renal transplantation
cotinine is considered a promising biomarker of smoking exposure
level of evidence is 5
Nicotine addiction is complex and the rate of successful prolonged abstinence without any intervention is dramatically low. Different therapeutic approaches for smoking patients are available and have proven their efficacy. They should be offered whenever possible
Even if they no longer smoke, donors with a smoking history require close observation due to increased risk of CKD development after kidney donation.
Yoon, Y. E., Lee, H. H., Na, J. C., Huh, K. H., Kim, M. S., Kim, S. I., … Han, W. K. (2018). Impact of Cigarette Smoking on Living Kidney Donors. Transplantation Proceedings, 50(4), 1029–1033. doi:10.1016/j.transproceed.2018.02.050
10.1016/j.transproceed.2018.02.050
Smoking in Renal Transplantation; Facts Beyond Myth
INTRODUCTION
Smoking is a challenging health care problem; it has a well-established correlation with many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death.Cigarette smoking assumes to have a role in atherosclerosis, endothelial dysfunction, progression of vascular disease progression of proteinuria, as it contains large amounts of free radicals.This makes smoking a significant renal risk factor, with considerable consequences on health care budget.
The effect of smoking is aggravated in renal trans- plant recipients due to the effect of immune suppression medications on carcinogenesis, in addition to the effect of chronic kidney disease itself on cardiovascular risk and mortality.
EffECTs Of smOkINg ON ThE kIDNEy
many studies confirmed the role played by smoking in the progression of many intrinsic renal diseases (e.g., diabetic nephropathy, IgA nephropathy and autosomal dominant polycystic kidney disease)
Ritz et al, reported a significant increase in arginine vasopressin levels and serum epinephrine .There was an increase in renal vascular resistance by 11% and a decrease in the glomerular filtration rate (GFR) by 15%.
Pinto-Sietsma et al, documented the presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment in this screening. These findings were less obvious or absent in former smokers.
RECIpIENT smOkINg aND TRaNsplaNTaTION OUTCOmE
Smoking is a well-known risk factor for cardiovascular disease. Ponticelli et al,have addressed the role of cardiovascular disease as the leading cause of death in renal transplant recipient. The development of de novo cardiovascular insult in the first year post-transplant was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and duration of dialysis.
The second leading cause of death post-trans- plantation was malignancywith a clear association between smoking and increased risk for certain types of malignancy.
Zitt et al, had a unique approach by studying the relation between smoking and renal biopsy findings .Current smokers had an increase in the severity of vascular intimal fibrous thickening .While the degree of chronic sclerosing nephropathy and arteriolar hyalinosis were associated with the duration of time post-transplantation.
Most of these studies have revealed a clear benefit of smoking cessation on graft survival, but the effect on patient survival is less clear possibly reflecting the permanent atherosclerotic effect on the vascular system.
EffECT Of smOkINg habIT Of
kIDNEy DONOR ON ThE OUTCOmE Of
TRaNsplaNTaTION
Although it makes sense that the recipient’s smoking will have an impact on his own longevity, it’s astonishing to learn that recipient survival even years after transplantation will be impacted by donor smoking.
According to Lin et al., a donor’s smoking behavior has a minor but statistically significant impact on recipient and graft survival.
smOkINg bIOmaRkER aND RENal TRaNsplaNTaTIO.
The main metabolite of nicotine is cotinine. Due to its lengthy half-life (16 h vs. 2-3 h for nicotine), which may be detected in plasma or urine, it has a reasonably steady level. Cotinine is regarded as a possible biomarker of smoking exposure because of these factors.
Level 3
Counseling the recipients to quit smoking at least 4 weeks before transplantation by helping them through special programs that explain the harm of smoking on kidney and heart as well.
INTRODUCTION
Smoking has a well-established correlation with many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death.
Cigarette smoking assumes to have a role in atherosclerosis, endothelial dysfunction, progression of vascular disease progression of proteinuria, as it contains large amounts of free radicals.
effect of smoking is aggravated in renal transplant recipients due to the effect of immune suppression medications on carcinogenesis, in addition to the effect of chronic kidney disease itself on cardiovascular risk and mortality.
Effect of smoking on the kidney:
There was an increase in renal vascular resistance by 11% and a decrease in the glomerular filtration rate (GFR) by 15%.
Also its documented the presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment in this screening. These findings were less obvious or absent in former smokers.
The effect of recipient smoking and transplant outcome:
The development of de novo cardiovascular insult in the first year post-transplant was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and duration of dialysis.
The second leading cause of death post-transplantation was malignancy with a clear association between smoking and increased risk for certain types of malignancy.
Effect of smoking habit of kidney donor on the outcome of transplantation:
smoking habit of the donor has mild, yet statistically significant effect on recipient survival and graft survival .
Smoking biomarker and renal transplantation Smoking exposure :
Cotinine is the major metabolite of nicotine. It has a relatively constant level due its long half-life (16 h vs 2-3 h for nicotine), which can be measured in plasma or urine. For these reasons, cotinine is considered a promising biomarker of smoking exposure.
should pay more attention to donor and recipient smoking cession program ,education
and drugs therapy for those who failed education and smoking quit session.
INTRODUCTION
Smoking is a challenging health care problem; it has a well-established correlation with many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death
. Cigarette smoking
assumes to have a role in atherosclerosis, endothelial dysfunction, progression of vascular disease progression of proteinuria, as it contains large amounts of free radicals
This makes smoking a significant renal risk
factor, with considerable consequences on health care budget
Effects of smoking on the kidney
The hazards of smoking were investigated thoroughly in association with cardiovascular disease, lung disease and oncogenesis. However, the effect of smoking on healthy kidney and progression of primary kidney diseases did not attract great attention
Recipient smoking and transplantation outcome
Smoking is strongly correlated to some of the potentially fatal outcomes, and there is some evidence that these complications are aggravated in solid organ transplant recipients
Smoking is a well-known risk factor for cardiovascular disease. Ponticelli et al[7]
have addressed the role of
cardiovascular disease as the leading cause of death in renal transplant recipient. The development of de novo cardiovascular insult in the first year post-transplant was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and duration of dialysis
Effect of smoking habit of kidney donor on the outcome of transplantation
It may be logic that the recipient smoking will affect his own survival, but surprisingly, even the donor smoking will affect the recipient survival years after transplantation
. Lin et Al have analysed data from the United Network for Organ Sharing from 1994 to 1999, and they declared that smoking habit of the donor has mild, yet statistically significant effect on recipient survival (HR = 1.06, P < 0.05), and graft survival (HR = 1.05, P < 0.05).
Smoking biomarker and renal transplantation
Smoking exposure and analysis of dose of smoking depends on self-reporting in most of the studies
which we strongly believe it lacks accuracy. A proper estimation of the risks associated with tobacco use depends on accurate measurement of exposure, which may be difficult in certain population such as pregnant women and parents of young children, where smoking considered socially unaccepted
The use of cotinine also has its limitations. Cotinine
level is a reflection of smoking over the past few days, and this may be misleading if the patient is smoking occasionally (like in weekends) or if the patient was smoking less due to a period of illness. The second limitation lies in its inability to differentiate between never-smoking and former-smoking
Differentiating
never-smoking from former-smoking is clinically relevant as former-smoking was proved to be associated with increasing risk of recipient mortality
We believe that the combination of cotinine measurement and self-reporting of smoking exposure will be the most reliable approach in evaluating renal transplant population.
Conclusion
Smoking remains a major modifiable health care challenge; it is the leading cause of variable morbidities and mortality. The use of smoking biomarkers proved to be reliable in evaluation and quantification of smoking exposure in the transplant population. Donor smoking and recipient former smoking proved to have a negative impact on survival. Transplant community should pay more attention to donor and recipient smoking cessation programs.
Level 5
Councilling with our candidate about the risk of smoking on heart and kidneys
Smoking is a risk factor of CVD, pulmonary diseases, malignancy and mortality.
It is associated with increased exposure to nicotine, AVP, adrenaline, reno-vascular resistance, urine ACR and GFR reduction.
Smoking has negative impact on progressive course of diabetic kidney disease, IgA nephropathy and polycystic kidneys.
Increased malignancy with smoking leads to reduced graft and patient survival.
Serum cotinine levels can be used to evaluate potential smoker transplant recipients.
Level:
Level 5, Narrative review.
Smoking cessation:
Counselling, abstain smoking 4 weeks pre -Tx, using smoking cessation programs, pharmacological approach is very helpful.
Smoking potential donors could have reduced GFR, patient survival, increased peri-operative complications, risk of malignancy ,wound infections and cardio-vascular disease.
Summarization of the article:
The correlation between renal outcomes and smoking hasn’t really been studied, even though arteriosclerotic diseases might bring up some risk.
A smoking recipient would have the risk of cardiovascular diseases. However, the study by Zitt et al showed increasing severity of fibrous thickening of the vascular intima and in arteriolar hyalinosis and the degree of chronic sclerosing nephropathy had a correlation with duration of post-transplantation time, through biopsy of kidney transplant recipients
Studies have shown the existence of a lower glomerular filtration rate and a lower graft survival in smoker donors. Self-report studies asses the smoking burden, however, their accuracy is very questionable concerning specific groups, in addition to the presence of various tobacco burdens in different types of cigarettes, requires an accurate and valid smoking biomarker.
The level of evidence provided by this article is 5, since it is a review.
Helping renal transplant patients to stop smoking:
Through the interdisciplinary program, focused on quitting cigarettes, they would have multidisciplinary support with various specialties for: cardiology, pulmonology, etc.
The effect of smoking on kidney donors:
There was a correlation between the existence of microalbuminuria and its collateral kidney damage, and the dose of smoking in the study done by Pinto Sietsma et al. In other studies, they showed the decrease in the glomerular filtration rate (GFR) by 15% and an increase in renal vascular resistance by 11% (studies such as that done by Ritz et al,).
Q1 Briefly summarise this article?
Smoking in Renal Transplantation; Facts Beyond Myth
Abstract
There are evidence correlating tobacco use with pathological changes in the normal kidneys. This effect is obvious on the renal allograft may be due to the chronic immune suppression status and the metabolic effect of the drugs. Smoking associated with lower patient and graft survival. Smoking cessation proved to improve graft survival and to a lesser extent recipient survival. Even receiving a renal transplant from a smoker donor increases the risk of death for the recipient and carries apoorer graft survival compared to non-smoking donors.
INTRODUCTION:
Cigarette smoking assumes to have a role in atherosclerosis, endothelial dysfunction, progression of vascular disease progression of proteinuria, as it contains large amounts of free radicals.
The effect of smoking is aggravated in renal transplant recipients due to the effect of immune suppression medications on carcinogenesis, in addition to the effect of chronic kidney disease itself on cardiovascular
risk and mortality.
Effects of smokin g on the kidney:
studies proved the role of smoking in the progression of many renal diseases (diabetic nephropathy, IgA nephropathy and autosomal dominant polycystic kidney disease).In one study through the effect of smoking there is an increase in renal vascular resistance by 11% and a decrease in the glomerular filtration rate (GFR) by 15%. these effects most probably due to effect of nicotine itself as these findings were reproduced by using nicotine containing gum.
Pinto-Sietsma et al, report the presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment .
Recipient smoking and transplantation outcome :
Smoking is a well-known risk factor for cardiovascular disease. Ponticelli et al report the role of cardiovascular disease as the leading cause of death in renal transplant recipient. The development of cardiovascular insult in the first year post-transplant was associated with smoking and other factors .
The second leading cause of death post-trans plantation was malignancy with a clear association between smoking and increased risk of malignancy. It worth to mentioning that Zitt et al report that Current smokers had an increase in the severity of vascular intimal fibrous thickening . Most of these studies have revealed a clear benefit of smoking cessation on graft survival.
Effect of smoking habit of kidney on the outcome of transplantation:
It is logic that the recipient smoking will affect his own survival, but, even the donor smoking will affect the recipient survival years after transplantation. Lin et al, report that smoking of the donor has mild, yet statistically significant effect on recipient survival and graft survival . Underwood et al, report that the effect of donor smoking on graft survival was statistically insignificant, unlike the recipient smoking which proved to be significant. the recipient survival was negatively correlated to donor smoking , and recipient smoking . Heldt et al report that the recipients of smoking donors had lower calculated GFR.
Smoking biomarker And renal transplantation:
Cotinine is the major metabolite of nicotine. It has a relatively constant level due its long half-life , which can be measured in plasma or urine. For these reasons, cotinine is considered an exposure promising biomarker of smoking.
Conclusion :
Ø Smoking remains a major modifiable health care challenge;
Ø it is the leading cause of variable morbidities and mortality.
Ø The use of smoking biomarkers proved to be reliable in evaluation and quantification of smoking exposure in the transplant population.
Ø Donor smoking and recipient former smoking proved to have a negative impact on survival.
Ø Transplant community should pay more attention to donor and recipient smoking cessation programs
Q2 – What is the level of evidence provided by this article?
Level 5
Q3- How do you help renal transplant patients to stop smoking?
He may need multidisciplinary team work and to put patient in smoking cessation program.
Q4- What is the effect of smoking on kidney donors?
Like its effect on any individual it is increase the incidence of cardiovascular , pulmonary disease – COPD , malignancy.
Summary of Smoking in Renal Transplantation; Facts Beyond Myth The aim of this work is to review the current evidence to improve our understanding of this article’s topic. This will help to guide better-designed studies in the future.
Introduction
The effect of smoking aggraded in renal Transplant recipients due to the effect of immune suppression medication is carcinogenesis and effect on CKD, CVS, and mortality
Effect of smoking on the kidney
The effect of smoking a healthy kidney and release progression of some renal diseases e.g diabetic nephropathy, IgA nephropathy, and autosomal dominant polycystic kidney disease.
Presence of a dose-dependent association between smoking and the development of both microalbumin and renal impairment in this severing this case study.
Recipient smoking and Transplantation outline
Development of de Novo CVS insult in the first year
Post-transplant was associated with pre-existing CVS disease older age pre-transplant HTN smoking and duration of dialysis
Second leading cause of death the post-transplant was malignancy and there is an association between smoking and increased risk for a certain type of malignancy
Effect of the smoking habit of kidney donor on the out came of transplantation
Recipient and donor smoking effect recipient survival after transplantation
The study evaluated 100 lives donors who smoked and at a mean follow-up of 25 months, this found-that recipients of smoking donors had lower calculated GFR
Smoking Biomarker and Renal Transplantation:
The need for an accurate biomarker for tobacco smoking is crucial because the same patient can not recall the number of cigarettes accurately (2) dose is different based on habit and type of cigarettes.
Continue is the metabolism of nicotine has a long half-life 16 versus 2-3 hours for nicotine
the aim was to investigate the relationship of self-reporting and cotinine exposure in the transplant population and to evaluate the use of cotinine as an alternative for self-report.
smoking increased the risk of mortality but not graft failure.
limitation of cotinine level is a reflection of smoking over the past few days and this may be misleading. if the patient smokes occasionally.
so the combination of cotinine measurement and self-reporting of smoking exposure will be the most reliable in the renal population.
Conclusion:
Smoking is cause variable morbidities and mortality
use of smoking biomarkers provide to be reliable in the evaluation of smoking exposure in transplant populations.
Donor and recipient smoking has a negative impact a survival.
level 5
how to help postrenal transplant patients to quit smoking?
patient should be counselled about the risk of smoking for CVS and the risk will be more than the general population in the presence of CKD also the immunosuppression put him at more risk and referral to a smoking session clinic
the risk of smoking in the kidney increases the microalbuminuria, the progression of CKD(decrease e GFR) and increase renal vascular resistance.
The relationship between smoking and renal outcomes has been little studied at this time, even with the risk that arteriosclerotic diseases can bring.
For the recipient who smokes, cardiovascular diseases are the big problem, but the study by Zitt et al was able to show, through biopsy of kidney transplant recipients, an increase in the severity of fibrous thickening of the vascular intima and in the degree of chronic sclerosing nephropathy and arteriolar hyalinosis were associated with duration of post-transplantation time.
For the donor who smokes, studies have already shown the existence of a lower graft survival and a lower glomerular filtration rate.
Assessment of smoking burden relies on self-report studies, but the accuracy of these is highly questionable for certain populations , as well as the presence of different tobacco burdens in different types of cigarettes, drives the need for a valid and accurate biomarker for smoking .
Level 05 – because is resume review
In our center, he receives multidisciplinary support through the interdisciplinary program (various specialties: cardiology, pulmonology, etc.) specifically for smoking cessation.
The study by Pinto Sietsma et al., noticed a relationship between the dose of smoking and the existence of microalbuminuria and with it kidney damage. In other studies, such as that by Ritz et al, it was shown that there is an increase in renal vascular resistance by 11% and a decrease in the glomerular filtration rate (GFR) by 15%
Smoking is associated with high risk of CVD, pulmonary disease, malignancy and mortality.
Smoking leads to increased exposure to nicotine, increased AVP, increased adrenaline, increased reno-vascular resistance, increased urine ACR and reduced GFR.
Smoking is linked to progressive course of diabetic kidney disease, IgA nephropathy and polycystic kidneys.
Malignancy is increased with smoking that leads to reduced graft and patient survival.
Serum cotinine levels can be used to evaluate transplant recipients.
Level 5, Narrative review.
Counselling, stop smoking 4 weeks before Tx, smoking cessation programs, pharmacological therapies are very helpful.
Can lead to reduced GFR, reduced patient survival, increased peri-operative complications, wound infections, increased risk of malignancy and cardio-vascular disease.
INTRODUCTION
Smoking is known to cause serious cardiovascular, pulmonary diseases, malignancy and death. Smoking accelerates atherosclerosis, induces endothelial dysfunction, progression of vascular disease, progression of proteinuria via production of large amounts of free radicals.
The effect of immunosuppressive therapy enhances carcinogenesis in renal transplant
recipients besides the cardiovascular risk and mortality manifested by the previous state of chronic renal disease are additive factors aggravated by smoking.
Hazards of smoking
Several studies highlighted the fact that smoking enhances the progression of various intrinsic renal diseases like diabetic nephropathy, IgA nephropathy and autosomal dominant polycystic kidney disease.
Ritz et al assessed the effect of smoking on healthy normotensive individuals, they found an increase in renal vascular resistance by 11% and a decline in the glomerular filtration rate (GFR) by 15%.other study conducted by Pinto-Sietsma et al to determine the effect of smoking on the development of albuminuria and renal impairment in non-diabetic population revealed the presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment.
Recipient smoking and transplantation outcome
Hazards of smoking are known to be aggravated in solid organ transplant recipients. According to Ponticelli et al the leading cause of death in renal transplant recipients is cardiovascular disease. Cardiovascular events can occur denovo post-transplant due to pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and long duration of dialytic support.
Malignancy is the second leading cause of death post-transplantation which is also linked to smoking and increased susceptibility to certain types of malignancy.
Zitt et al had a characteristic approach by assessing the relation between smoking and renal biopsy findings of renal transplant recipients. They determined that there is an increased severity of vascular intimal fibrous thickening in current smokers, also the longer duration of smoking post transplantation, the higher the degree of chronic sclerosing nephropathy and arteriolar hyalinosis.
Other studies came out with the presence of a clear benefit of smoking cessation on graft survival.
Effect of smoking habit of kidney donor on the outcome of transplantation
It was astonishing that even the donor smoking will affect the recipient survival years after transplantation. The recipient survival was negatively correlated to donor smoking according to Underwood et al. The recipients of smoking donors had lower calculated GFR as declared by Heldt et al.
Smoking biomarker and renal transplantation
It is believed that self-reporting about smoking is known to be inaccurate urging the need to establish a valid accurate biomarker for tobacco smoking. Cotinine is the major metabolite of nicotine with a relatively constant level as it has a long half-life. It can be monitored in plasma or urine. Thus, cotinine is regarded as a promising biomarker of smoking exposure.
Cotinine measurement can be misleading if the patient is smoking occasionally as weekends or during period of illness. Another limitation is the inability to discriminate between never-smoking and former-smoking.
Active smoking had a negative impact on both patient and graft survival, while former smokers had high risk of mortality only without risk of graft failure.
Conclusion: Transplant communities have to pay attention to both donor and recipient smoking cessation programs.
Level of evidence is 5.
To help renal transplant recipients to quit smoking , psychosocial support is offered ,healthy lifestyle including healthy diet and exercises is advised, patient counselling about smoking hazards on both survival and graft should be discussed and finally enrollment in smoking cessation program.
Effect of smoking on kidney donors:
They require close observation due to increased risk of CKD development after kidney donation. Smoking cessation strategies should be implemented in kidney donors.
Tobacco smoking in 40 year donors and more is associated with post-operative development of CKD after 24 months.
Briefly summarize this article
What is the level of evidence provided by this article?
Level 5 narrative review
How do you help renal transplant patients to stop smoking?
By showing and educating about the ill effects of smoking
The patient should be referred to psychiatrist and enrolled in de-addiction program
Nicotine gums or patches may initially help in de-addiction
What is the effect of smoking on kidney donors?
Smoking is a known risk factor for hypertension, cardiovascular morbidity and malignancy
These all factors have ill effects on donor life
Briefly summarize this article
Introduction
The smoking effect has been well documented on cardiovascular and pulmonary diseases including malignancies and death, but we have limited data about its effect on the renal system and in particular renal transplantation population however, based on the available retrospective small studies still smoking can have a harmful outcome on the renal system due to the effect of the free radicals in addition to the augmented effect due to low immunity and immunosuppression medications, CKD with further increased risk of atherosclerosis and CVD and malignancies, and affect the graft and patient survival even transplantation from smoker donors found to have an impact on the transplant outcome compared to nonsmoker donors anew promising biomarkers cotinine have more objective indication about the smoking effect and can be a goal for future prospective studies to improve our knowledge about this important preventive risk factors
This study focused on reviewing the previous work on the smoking consequence and addressing the limitation of previous studies and help for future prospective research that aid and guide us for a better understanding of this hazardous defensive risk factor.
Effect of smoking on the kidneys
Smoking can worsen the progress of many primary kidney diseases like Diabetic nephropathy, IgA nephropathy, and APCKD.
The nicotine effect of smoking can lead to an increase the arginine level and epinephrin based on small studies and increased renal vascular resistance BY 11% also smoking can lead to a reduction in GFR by 15% compared to nonsmokers and in one cross-sectional study, they found that smoking associated with dose-related increase risk of microalbuminuria and deterioration of renal function in nondiabetic healthy populations.
Effect of smoking on kidneys transplant recipients
Most of the studies are retrospective and have small sample size however they concluded the deleterious effect of smoking on graft survival and to less extent on patient survival due to co-existing cardiovascular risk and atherosclerosis also one interesting histological finding in one report confirm the harmful effect of smoking on the graft survival by the increased risk of vascular change including arteriolar fibrous intimal thickening which can contribute to chronic allograft nephropathy and graft loss (zitt et al ).and in one study reported in addition to worsening graft and patient survival also smoking the increased risk of rejection( Nogueira et al[18)
Effect of the smoking habit of kidneys transplant donors on the recipient outcome
Diverse results from the limited small studies however the effect of donor smokers significantly impacted the recipient survival
Smoking biomarkers and kidney transplant
Cotinine is a promising biomarker for the exposure of smoking kidney transplant recipients as having a longer half-life compared to nicotine and can be measured in urine and plasma and give more objective results compared to self-reporting of smoking exposure for the former smoker but will be of limited value in recipients with occasional smoking habit, so the best would be a combination of self-reporting and cotinine level to give more accurate exposure in active smokers, former smokers and never smoke recipients as each one has a clinical correlation with graft, patient outcome, and recipient mortality.
What is the level of evidence provided by this article?
Level 5 narrative review of retrospective small sample size studies
How do you help renal transplant patients to stop smoking?
Should be involved in a smoking cessation program, with group therapy and psychosocial support
What is the effect of smoking on kidney donors?
Donor smoking in some report significantly impact the recipient’s survival
Smoking in Renal Transplantation; Facts Beyond Myth
Most of the studies focused on the association between smoking and cardiovascular
disease, pulmonary diseases, malignancy and death. However, the direct effect of smoking on the renal system was undermind. There is emerging evidence correlating tobacco use with pathological changes in the normal kidneys. The effect is more obvious on the renal allograft most probably due to the chronic immune suppression status and the metabolic effect of the drugs.
Effects of Smoking ON The Kidney:
The hazards of smoking were investigated thoroughly in association with cardiovascular disease, lung disease and oncogenesis. Pinto-Sietsma et al performed a leading cross sectional study on 7476 participants to evaluate the effect of smoking on the development of albuminuria and abnormal kidney functions in non-diabetic population. They documented the presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment in this screening.
Recipient Smoking And Transplantation Outcome:
Ponticelli et al have addressed the role of cardiovascular disease as the leading cause of death in renal transplant recipient. The development of de novo cardiovascular insult in the first year post-transplant was associated with pre-existing cardiovascular disease,
older age, pre-transplant hypertension, smoking and duration of dialysis.
smoking also increased risk for certain types of post-transplantation malignancy. Zitt et al had a unique approach by studying the relation between smoking and renal biopsy findings of 76 kidney transplant recipients. Current smokers had an increase in the severity of vascular intimal fibrous thickening (p = 0.004). Whilethe degree of chronic sclerosing nephropathy (p = 0.05) and arteriolar hyalinosis (p < 0.001) were associated with the duration of time post-transplantation.
Most of these studies have revealed a clear benefit of smoking cessation on graft survival.
Effect of Smoking Habit of Kidney DONOR ON The Outcome of Transplantation:
lin et al have analysed data from the United Network for Organ Sharing from 1994 to 1999 and they declared that smoking habit of the donor has mild, yet statistically significant effect on recipient survival and graft survival
Underwood et al state that The effect of donor smoking on graft survival was
statistically insignificant (unlike the recipient smoking which proved to be significant
However, the recipient survival was negatively correlated to donor smoking (HR = 1.93,
95%CI: 1.27-2.94, p = 0.002) and recipient smoking (HR= 1.74, 95%CI: 1.01-3.00, p = 0.048)
Smoking Biomarker And Renal Transplantation:
The use of smoking biomarkers proved to be reliable in evaluation and quantification of smoking exposure in the transplant population Cotinine is the major metabolite of nicotine. It has a relatively constant level due its long half-life (16 h vs 2-3 h for nicotine), which can be measured in plasma or urine. For these reasons, cotinine is considered a promising biomarker of smoking exposure
Level 5 * review
Most the studies have revealed a clear benefit of smoking cessation on graft survival, so am going to:
Inform patients about importance of smoking cessation
Behavioural therapy and referral to specialist in smoking cessation
Group therapy , psychological support
Donor smoking proved to have a negative impact on recipient survival statistically significant and on graft survival.
Briefly summarise this article
– Cigarette smoking assumes to have a role in atherosclerosis, endothelial
dysfunction, progression of vascular disease progression of proteinuria, as it contains large amounts of free radicals. This makes smoking a significant renal risk
factor.
The effect of smoking is aggravated in renal transplant recipients due to the effect of immune suppression medications on carcinogenesis, in addition to the effect
of chronic kidney disease itself on cardiovascular risk and mortality.
-One study showed a significant increase in arginine vasopressin levels and serum epinephrine as the effect of smoking on healthy normotensive volunteers. Also, There was an increase in renal vascular resistance by 11% and a decrease in the
glomerular filtration rate (GFR) by 15%. They assumed these effects are secondary to nicotine itself .
-There is a dose-dependent association between smoking and development of
both microalbuminuria and renal impairment .
-Smoking is a well-known risk factor for cardiovascular disease. The development of de novo cardiovascular insult in the first year post-transplant was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and duration of dialysis.
-The second leading cause of death post-transplantation was malignancy with a clear association between smoking and increased risk for certain types of malignancy.
-Renal –transplant recipients who smoke had an increase in the severity of
vascular intimal fibrous thickening .
-Many studies have revealed a clear benefit of smoking cessation on graft survival, but the effect on patient survival is less clear possibly reflecting
the permanent atherosclerotic effect on the vascular system.
-The donor smoking will affect the recipient survival years after transplantation.
– The tobacco dose differs between individuals due to the difference between cigarettes as well as the difference in inhaling habits (passive
smoking)
-Cotinine is the major metabolite of nicotine. It has a relatively constant level due its long half-life (16 h vs 2-3 h for nicotine), which can be measured in plasma
or urine. cotinine is considered a promising biomarker of smoking exposure.
-Active smoking had a negative impact on patient and graft survival, while
former smokers had increased the risk of mortality but not graft failure.
-The combination of cotinine measurement and self-reporting of smoking exposure will be the most reliable approach in evaluating renal transplant
population.
What is the level of evidence provided by this article?
Level 5
How do you help renal transplant patients to stop smoking?
By referring them to a smoking cession program.
What is the effect of smoking on kidney donors?
– No difference in postoperative complications was seen in smoking versus non-smoking donors but affect kidney in the future.
Summary
This article focusses on the topic of smoking among renal transplant recipients. The direct effects on the kidneys and renal system have been studied. Pathological changes in the kidneys due to smoking have been noted.
Smoking directly affects the kidneys, besides also affecting the lungs, heart, and leading to cancer and death. Kidneys which are otherwise healthy can also be affected to a great extent from regular tobacco consumption. The renal allograft is even more affected due to the constant immunosuppression that the body is under after kidney transplant. Smoking directly lowers patient and graft survival rates. Along the same lines, cessation of this harmful habit can lead to better rates of graft survival and patient survival. This is why smoker donors are not accepted in many centers since the risk of kidney failure and death is carried over to the recipient.
Since exposure to smoke and dose analysis is mostly self reported, it is often difficult to accurately assess the impact of smoking on one particular organ system. This could possibly be remedied by the introduction of a biomarker called Cotinine. Cotinine is a major metabolite of nicotine with a long half life leading to its constant level. It can be measured in plasma or urine. However, since Cotinine can only reveal smoking exposure for the past few days, it can be misleading in some cases where patients smoke on selected days and not other days or if the patient is a strictly occasional smoker.
In addition, Cotinine cannot different between a person who never smoked to a person who smoked previously but later gave up on the habit and now is completely free from it. This is significant because the outcome of both these groups is not the same. Patients who used to smoke have a raised risk of mortality.
In conclusion, smoking is a modifiable habit and has a multi pronged effect on the human body. With respect to kidneys, it can damage renal functioning and especially cause severe stress on the allograft leading to possible graft failure and even death of the patient. More smoking cessation programs need to be created that are workable and sustainable in the long term.
Level of evidence
Narrative review – Level of evidence 5.
How to help patients overcome smoking
Smoking was associated with lowering patient and graft survival. Smoking cessation proved to improve graft survival and to a lesser extent recipient survival.
Even receiving a renal transplant from a smoker donor increases the risk of death for the recipient and carries a poorer graft survival compared to non-smoking donors
Level V
– Education about the risk of smoking on the graft and on the life outcome in general
– Referral to smoking cessation team, and may need psychological support.
• What is the effect of smoking on kidney donors?
receiving a renal transplant from a smoker donor increases the risk of death for the recipient and carries a poorer graft survival compared to non-smoking donors. Furthermore; it increases the risk of cardiovascular and pulmonary diseases; hence, high risk of mortality
Smoking is a challenging health care problem; it has a well-established correlation with many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death.
The effect of smoking is aggravated in renal transplant recipients due to the effect of immunosuppressive medications on carcinogenesis, in addition to the effect of chronic kidney disease itself on cardiovascular risk and mortality.
Effects of smoking on the kidney:
A study to evaluate the effect of smoking on the development of albuminuria and abnormal kidney functions in the non-diabetic population found the presence of a dose-dependent association between smoking and the development of both microalbuminuria and renal impairment. These findings were less obvious or absent in former smokers.
Recipient smoking and transplantation outcome:
Complications of smoking are aggravated in solid organ transplant recipients.
The development of de novo cardiovascular insult in the first year post-transplant was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and duration of dialysis.
There is a clear association between smoking and increased risk for certain types of malignancy.
A study evaluated the relation between smoking and renal biopsy findings of 76 kidney transplant recipients. Current smokers increased the severity of vascular intimal fibrous thickening, and the degree of chronic sclerosing nephropathy and arteriolar hyalinosis was associated with the duration of time post-transplantation.
Effect of the smoking habit of kidney donors on the outcome of transplantation:
Even donor smoking will affect the recipient’s survival years after transplantation.
Data from UNOS showed that the smoking habit of the donor has a mild yet statistically significant effect on recipient survival and graft survival.
Another study showed that recipients of smoking donors had a lower GFR at a mean follow-up of 38 months.
Smoking biomarker and renal transplantation:
Cotinine is the major metabolite of nicotine. It has a relatively constant level due to its long half-life, which can be measured in plasma or urine. For these reasons, cotinine is considered a promising biomarker of smoking exposure.
A study showed that active smoking had a negative impact on patient and graft survival; former smokers had increased the risk of mortality but not graft failure. They documented that cotinine measurement provides a valid alternative to self-reported smoking exposure, and it may even be preferred over self-reporting in epidemiological studies.
Limitations of using cotinine:
A combination of cotinine measurement and self-reporting of smoking exposure will be the most reliable approach to evaluating renal transplant population.
Level 5 (review article)
Smoking is associated with a short-term risk of developing CKD.
Smoking is a challenging health care problem; it has a well-established correlation with many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death. There is not enough high quality research data on effect of smoking in kidney transplant patients. It has been shown in different studies that smoking leads to increased albuminuria,reduces GFR and can lead to progression of intrinsic kidney diseases like IgA Nephropathy, ADPKD and Diabetic Nephropathy.
Cardiovascular disease and malignancy are two leading causes of death in post kidney transplant patients and smoking is well known risk factor for both these conditions.The available limited data has shown clear benefit of smoking cessation on graft survival but not on patient survival.
The effect of donor smoking on graft survival has shown statistically significant effect in one study however it was insignificant in another study done by underwood and colleagues.
Cotinine is the major metabolite of nicotine. It has a relatively constant level due to its long half-life (16 h vs 2-3 h for nicotine), which can be measured in plasma or urine. For these reasons, cotinine is considered a promising biomarker of smoking exposure as self reporting has many limitations.
The use of cotinine also has its limitations. Cotinine level is a reflection of smoking over the past few days, and this may be misleading if the patient is smoking occasionally (like in weekends) or if the patient was smoking less due to a period of illness. The second limitation lies in its inability to differentiate between never-smoking and former-smoking. Differentiating never-smoking from former-smoking is clinically relevant as former-smoking was proved to be associated with increasing risk of recipient mortality.
I think in view of above all smoking cessation programs should be incorporated as part of kidney transplant work up
Narrative review evidence level v.
we should explain patients about deleterious effects of smoking on graft and patient outcome and also adopt a smoking cessation program for such patients.
Smoking will increase risk of albuminuria, low GFR for kidney donors further it is an independent cause of increased Cardiovascular mortality
INTRODUCTION
· It’s known that smoking is one of the leading causes of cardiovascular diseases, pulmonary diseases, malignancy and death.
· smoking free radicals have a role in atherosclerosis, endothelial dysfunction, progression of vascular disease and proteinuria
· smoking effect more serious in transplant recipients due to the effect of immune suppression drugs on carcinogenesis and CKD effect on cardiovascular risk and mortality
Effects of smoking on the kidney
· the effect of smoking on healthy kidney and progression of primary kidney diseases is neglectable
· smoking could have a role in the progression of diabetic nephropathy, IgA nephropathy and autosomal dominant polycystic kidney disease
· Ritz et al found that smoking increased renal vascular resistance by 11% and a decreased the glomerular filtration rate (GFR) by 15%
Recipient smoking and transplantation outcome
· Many studies have revealed a clear benefit of smoking cessation on graft survival, but not on patient survival, maybe due to permanent atherosclerotic effect on the vascular system
Effect of smoking habit of kidney donor on the outcome of transplantation
· Lin et al found that smoking habit of the donor has mild, yet statistically significant effect on recipient survival, and graft survival
· While Underwood et al found that the effect of donor smoking on graft survival was statistically insignificant, unlike the recipient smoking which proved to be significant
· the recipients of smoking donors had lower calculated GFR (Heldt et al)
Smoking biomarker and renal transplantation
· Cotinine is the major metabolite of nicotine
· Cotinine has a relatively constant level due its long half-life, which can be measured in plasma or urine
· Hellemons et al documented that cotinine measurement provides a valid alternative to self-reported smoking exposure, and it may even be preferred over self-reporting in epidemiological studies
· Limitations of Cotinine use:
1. if the patient is smoking occasionally or if the patient was smoking less due to a period of illness
2. cannot differentiate between never-smoking and former-smoking
· The authors believe that the combination of cotinine measurement and self-reporting of smoking exposure will be the most reliable approach in evaluating renal transplant population
Conclusion
· Smoking is the leading cause of variable morbidities and mortality.
· The use of smoking biomarkers proved to be reliable in evaluation and quantification of smoking exposure in the transplant population.
· Donor smoking and recipient former smoking proved to have a negative impact on survival. Transplant community should pursue donor and recipient to quit smoking
What is the level of evidence provided by this article?
Narrative review with evidence level 5
How do you help renal transplant patients to stop smoking?
What is the effect of smoking on kidney donors?
Introduction :
– Smoking is one of the preventable leading causes of death worldwide
– Smoking is a challenging health care problem; it has a well-established correlation with many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death
– There are emerging evidence correlating tobacco use with pathological changes in the normal kidneys. The effect is more obvious on the renal allograft most probably due to the chronic immune suppression status and the metabolic effect of the drugs. Several studies have documented a deleterious effect of smoking on the renal transplant recipients. Smoking was associated with lowering patient and graft survival. Smoking cessation proved to improve graft survival and to a lesser extent recipient survival. Even receiving a renal transplant from a smoker donor increases the risk of death for the recipient and carries a poorer graft survival compared to non-smoking donors.
Effects of smoking on the kidney
– many studies confirmed the role played by smoking in the progression of many intrinsic renal diseases (e.g., diabetic nephropathy, IgA nephropathy and autosomal dominant polycystic kidney disease)
– Pinto-Sietsma et al documented the presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment in this screening. These findings were less obvious or absent in former smokers
Recipient smoking and transplantation outcome
– Smoking is a well-known risk factor for cardiovascular disease. Ponticelli et al have addressed the role of cardiovascular disease as the leading cause of death in renal transplant recipient.
– The development of de novo cardiovascular insult in the first year post-transplant was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and duration of dialysis .
– The second leading cause of death post-transplantation was malignancy with a clear association between smoking and increased risk for certain types of malignancy .
Effect of smoking habit of kidney donor on the outcome of transplantation
– It may be logic that the recipient smoking will affect his own survival, but surprisingly, even the donor smoking will affect the recipient survival years after transplantation
Smoking biomarker and renal transplantation
– cotinine is considered a promising biomarker of smoking exposure.
– Hellemons et al studied 603 renal transplant recipients for a mean follow-up of 6.9 years. The aim was to investigate the relation of self-reporting and cotinine exposure in transplant population and to evaluate the use of cotinine as an alternative for self report . They concluded that active smoking had a negative impact on patient and graft survival, while former smokers had increased the risk of mortality but not graft failure. They documented that cotinine measurement (especially plasma cotinine) provides a valid alternative to self-reported smoking exposure, and it may even be preferred over self-reporting in epidemiological studies .
Conclusion
– Smoking remains a major modifiable health care challenge; it is the leading cause of variable morbidities and mortality. The use of smoking biomarkers proved to be reliable in evaluation and quantification of smoking exposure in the transplant population. Donor smoking and recipient former smoking proved to have a negative impact on survival. Transplant community should pay more attention to donor and recipient smoking cessation programs
– Level of evidence >>> level 5
– How do you help renal transplant patients to stop smoking?
– Counselling regarding hazards & effects of smoking & its impact on the graft survival
– Direct them to smoking cessation programs which include behavioural & pharmacological therapy
– What is the effect of smoking on kidney donor ?
-smoking is associated with atherosclerosis & CV morbidity which in turn will carry high risk to the kidney donors especially being solitary kidney
– smoking is associated with risk of malignancy ( lung cancer & bladder cancer )
-smoking will increase possibility of proteinuria which is associated with increased all cause mortality
– smoking cause rapid fall in GFR than non smoker
-smoking increase risks of perioperative complications
Smoking has impact on both patient and graft survival and graft survival improves after smoking cessation.
Donor smoking increases the risk of death for the recipient and negatively impacts graft survival.
Effects of smoking on the kidney
progression of many intrinsic renal diseases (e.g., diabetic nephropathy, IgA nephropathy & ADPKD) are well known.
smoking increases serum levels of AVP & epinephrine, renal vascular resistance, & decrease eGFR by 15%
associated with a dose dependent microalbuminuria & renal impairment in non-diabetic population
Recipient smoking & transplantation outcome
Smoking is an independent risk factor for CVD as we know CVD is the leading cause of death in renal transplant patients
Malignancy is the 2nd leading cause of death post-transplantation- smoking increases the risk
Smoking increases the severity of vascular intimal fibrous thickening on renal biopsy
There is a clear benefit of smoking cessation on graft survival; the effect on patient survival is less clear.
Effect of smoking habit of kidney donor on the outcome of transplantation:
Smoking habit of the donor has mild, but statistically significant effect on recipient survival & graft survival (Lin et al).
Underwood et al showed effect of donor smoking on graft survival was statistically insignificant, unlike the recipient smoking which proved to be significant.
The recipients of smoking donors had lower calculated GFR at a mean follow-up of 38 months
Smoking biomarker & renal transplantation
Cotinine (the major metabolite of nicotine) is a promising biomarker of smoking exposure. It has a longer half-life (16 h vs 2-3 h for nicotine) & can be measured in plasma or urine.
Plasma cotinine measurement provides a valid alternative to self-reported smoking exposure
What is the level of evidence provided by this article?
Level V
How do you help renal transplant patients to stop smoking?
offer smoking cessation programmes (SCPs) to all renal transplant candidates who are using tobacco products.
recommend smoking cessation at least 1 month before waitlisting
patients who continue to smoke to be eligible for KT with full informed consent regarding their increased risk of poorer outcomes.
Smoking is modifiable health risk factor associated with lowering patient and graft survival. Smoking cessation proved to improve graft survival and to a lesser extent recipient survival. Even receiving a renal transplant from a smoker donor increases the risk of death for the recipient and carries a poorer graft survival compared to non-smoking donors.
The effect of smoking is more in renal transplant recipients due to the effect of immune suppression medications on carcinogenesis and chronic kidney disease itself increase cardiovascular risk and mortality.
Recipient smoking will affect his own survival as well as donor smoking will affect the recipient survival years after transplantation.
Cotinine is considered a promising biomarker of smoking exposure as it is the major metabolite of nicotine. It has a relatively constant level due its long half-life and can be measured in plasma or urine. Cotinine is not reliable if the smoking is occasional or curtailed during illness. So, combining self-reporting of smoking with serum cotinine level would be helpful in evaluating transplant recipients.
Level of evidence: level 5 (narrative review)
– Counselling about the effect of smoking on their cardiovascular and pulmonary system, as well as its effects on the graft kidney.
– Smoking cessation programs include behavioral and pharmacological therapies (nicotine patches, bupropion, etc).
– Reduced graft survival
– Reduced patient survival
Briefly summarise this article
This article nicely reviews the available evidence on effects of smoking in renal transplantation.
Smoking has major deleterious effects of various organs of body. this is a well established fact in normal individuals. The common known side effects are atherosclerosis, vascular endothelial dysfunction and malignancies. But there is limited data , whether smoking causes much more serious effects on transplant recipients in comparision to normal individuals and does smoking in donors can also affect transplant outcomes.
Available studies as tabulated in the article are mostly retrospective and non-randomized.
Studies have shown that smoking also has direct effect on kidneys and this happens in dose dependent manner. More is the smoking, more are the chances of developing renal impairment and microalbuminuria.
There are three main effects of recipient smoking post transplantation:
There is also surprising evidence that donor smoking affects recipient survival post transplantation.
Analysis of smoking exposure in transplant recipients is usually inaccurate as it depends on data collected using self-reporting methods. Hence, there is need for a biomarker which can help removing this bias.
Cotinine which is metabolite of nicotine has shown promising prospects in this due to its constant level and long half life. But it has its own limitations.
Hence, a combination approach of cotinine estimation and self reporting can be quite reliable method of analysing effect of smoking in renal transplantation.
What is the level of evidence provided by this article?
It is level 3 evidence
How do you help renal transplant patients to stop smoking?
A good effective counselling and enrolling patient for regular counselling sessions for life style modification of risk factors is the key to its success. In India there is no structured program for smoking cessation.
Therefore, I would councel patient myself on his follow ups and refer him to councilor as well for smoking cessation
What is the effect of smoking on kidney donors?
kidney donors will survive as solitary kidney candidates after donation. So they are likely to face more side effects than a person with both native kidney faces due to smoking:
Khalil MAM, Tan J, Khamis S, Khalil MA, Azmat R, Ullah AR. Cigarette Smoking and Its Hazards in Kidney Transplantation. Adv Med. 2017;2017:6213814. doi: 10.1155/2017/6213814. Epub 2017 Jul 27. PMID: 28819637; PMCID: PMC5551477.
#Briefly summarise this article
# Introduction
*Smoking may lead to many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death.
*It has a role in atherosclerosis, endothelial dysfunction, progression of vascular disease progression of proteinuria, as it contains large amounts of free radicals.
*The effect of smoking is aggravated in KTR due to the effect of immune suppression
drugs on carcinogenesis, also the effect of CKD itself on cardiovascular risk and mortality.
# Effects of smoking on the kidney
*Many studies showed the role of smoking in the progression of many intrinsic renal diseases (e.g, diabetic nephropathy, IgA nephropathy and APKD), they reported a significant increase in arginine vasopressin levels (from 1.27 ± 0.72 to 19.9 ± 27.2 pg/ml) and serum epinephrine (from 37 ± 13 to 140 ± 129 pg/ml).
*There was an increase in renal vascular resistance by 11% and a decrease in the (GFR) by 15%.
*They documented the presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment, these findings were less obvious or absent in former smokers.
#Recipient smoking and transplantation outcome
*Smoking is a well-known risk factor for CVD. Ponticelli et al. showed the role of CVD as the leading cause of death in KTR.
*The development of de novo cardiovascular insult in the first year post-transplant
was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and duration of dialysis.
*The second leading cause of death post-transplantation was malignancy.
*Current smokers had an increase in the severity of vascular intimal fibrous thickening Most of studies showed clear benefit of smoking cessation on graft survival, but the effect
on patient survival is less clear possibly reflecting the permanent atherosclerotic effect on the vascular system.
# Effect of smoking habit of kidney donor on the outcome of transplantation
*Lin et al conducted that that smoking habit of the donor has mild, yet statistically significant effect on recipient survival.
*The effect of donor smoking on graft survival was statistically insignificant unlike the recipient smoking which proved to be significant
*Heldt et al reported that the recipients of smoking donors had lower calculated GFR at a mean follow-up of 38 months.
# Smoking biomarker and renal transplantation
*Smoking evaluation depends on self-reporting in most of the studies which we strongly believe it lacks accuracy.
*Evaluation of the risk of tobacco depends on accurate measurement of exposure, which may be difficult in certain population.
*Cotinine is the major metabolite of nicotine, it has a relatively constant level due its long half-life (16 h vs 2-3 h for nicotine) and can be estimated in the plasma and urine, for these reasons, cotinine is considered a promising biomarker of smoking exposure.
# What is the level of evidence provided by this article?
*Level 5
# How do you help renal transplant patients to stop smoking?
*Kidney donors and recipients with history of cigarette smoking should be referred to smoking cessation clinics, and they should be counseling about all the risk and outcome of recipients, donors and the graft.
The use of combination of cotinine measurement and self-reporting of smoking exposure will be the most reliable approach in evaluating renal transplant population.
# What is the effect of smoking on kidney donors?
*Kidney donors undergo general anesthesia for donor nephrectomy and are prone to develop complications in the perioperative period. *Cigarette smoking causes increased bronchial secretion and impaired mucociliary clearance.
*It also results in increased carboxyhemoglobin and secondary polycythemia.
*Pneumonia is the third most common infection after urinary tract and wound infection in kidney donors.
*Smokers have a higher risk of pulmonary and wound infections after surgery than nonsmokers.
*Amsterdam Forum Guidelines recommends cessation of cigarette smoking 6 weeks before kidney donation.
*There is a significantly higher death rate among kidney donors who were smokers.
*Cigarette smoking in cadaveric kidney donor may be associated with DGF.
*kidney donors who actively smoke or have a past history of tobacco use were found to have higher serum creatinine at end of 1 year as compared to non smokers.
*Recipients of kidneys from smokers had higher creatinine and lower GFR.
*However, Jha et al. found no difference in postoperative complications and graft survival between the two groups.
*Donor cigarette smoking reduced recipient survival.
For live kidney donors, transplantation provides an opportunity to quit cigarette smoking.
The article deals with smoking and transplant. Smoking is one of the leading causes of death that is preventable. Numerous studies have been conducted to associate smoking with other pathologies like cardiovascular diseases, peripheral vascular diseases, pulmonary diseases, malignancies like bladder, etc. most recent studies have correlated smoking with kidney diseases. It is also found that smoking aggravates renal transplant recipients due to immunosuppressive medications and possible carcinogenesis. Due to the cardiovascular effects, it has it can directly affect the kidneys causing CKD.
The effect of smoking on the kidneys; it has been found that smoking has an effect on the cardiovascular system causing cardiovascular diseases and peripheral diseases. Not only in this aspect but also affects the lungs and other systems. However, its effect on healthy kidneys and the progression of primary kidney diseases did not show much evidence.
Effects of smoking on recipient and transplant: smoking has strong implications on the transplant graft as it can aggravate its function and may lead to organ failure. These effects can be fatal. It is one of the leading risk factors for cardiovascular diseases in KT. Smoking is also correlated with malignancy in patients post-transplant and is a leading cause of death.
It is also noted that not only the recipient that smoking does affect but also donors. Due to the long-standing habit of smoking, the donor’s toxic habit will later have an effect on the graft survival years post-transplantation.
Smoking biomarker and renal transplant: cotinine is the major metabolite of nicotine from smoking. It has a long half-life of about 16 hours – 2-3 hours for nicotine. These biomarkers can be measured in the urine and plasma. Due to the long hours in the plasma, it is an ideal biomarker for smoking exposure.
Cotinine itself has its limitations. It reflects smoking has taken place a few days earlier and may not distinguish if smoking occurred during a period of illness or on weekends. It is difficult to know or differentiate between a person who never smokes or a former smoker.
How then do we encourage or help renal transplant patients to stop smoking:
Firstly, patient education is fundamental. The patient must know the consequences of smoking the graft, like failure and other complications. Once this is done objective studies must be conducted to provide evidence that smoking may have or the effect it may have on the GFRAT. So studies like cardiac evaluation, Xray, PFT and CPET.
Once the patient has understood the possible complications and outcomes, treatment must be provided to cease smoking and they are as follows:
1) Smoking cessation program
2) Have a smoking patch like the nicotine patch. Chewing gums
3) Group therapy
4) Referred to a psychologist
the level of evidence is 5
Briefly summarize this article
Smoking and effect on renal system especially in transplant population is less studied and most studies are retrospective and/or with small sample size.
Effect of smoking on kidneys:
Role of smoking in progression of intrinsic renal disease (IgA nephropathy, ADPKD, Diabetic nephropathy) has been confirmed in many studies.
Smoking effects in healthy volunteers has been studied by Ritz et al and found that level of arginine vasopressin and serum epinephrine was elevated in smokers. Increase in Renal vascular resistance by 11% and decrease in GFR by 15% found in smoking group.
Pinto-Sietsma et al demonstrated dose dependent association between smoking and development of microalbuminuria.
Effect of Recipient smoking and transplant outcome:
Cardiovascular disease and malignancy are leading cause of death in recipients and smoking has clear association between both in various studies.
Smoking increases severity of vascular intimal fibrous thickening in a unique study by Zitt etal which examines kidney biopsy. Graft survival and smoking cessation has a clear benefit.
Effect of smoking in kidney donor on Transplant Outcome:
There are mixed results of Donor smoking on Graft survival in few available studies. In a study by Heldt et al documented that recipients of smoking donors had lower calculated GFR at mean follow up of 38 months (37 versus 53 ml/min per 1.73m2)
Biomarkers of Smoking and Renal transplantation:
Smoking exposure and analysis of dose of smoking lacks accuracy. Accurate measurement of exposure is difficult due to recall bias, difference of tobacco dose and inhalation pattern.
Due to above lacuna, there is need of an accurate and valid biomarker of smoking.
Cotinine, a major metabolite of nicotine has half-life of 16 versus 2-3 hours of nicotine, is one such biomarkers but has few limitations. It can’t differentiate between occasional, never smoker, former smokers, and less frequent smokers.
Biomarker along with self-reported nicotine exposure will be best approach of evaluating effects of smoking on renal transplant.
Smoking is a major preventable factor which have negative impact on survival
What is the level of evidence provided by this article?
This is a narrative review of majorly Retrospective studies; hence level of evidence is 5.
How do you help renal transplant patients to stop smoking?
Educating renal transplant recipient in detail about association between smoking and cardiovascular, pulmonary diseases, proteinuria, malignancy, and negative impact on graft survival.
Also, it is important to mention here, effect of smoking is aggravated in recipients due to prior effect of CKD on cardiovascular system and relationship between immunosuppression and carcinogenesis which increases morbidity and mortality.
What is the effect of smoking on kidney donors?
Smoking predisposes Kidney Donors to its adverse effects on major systems of the body and adversely effects graft survival and GFR in recipients.
This is a narrative review article which is considered level 5.
The article discussed the deleterious effect of smoking on the native and transplanted kidney, a hidden and underestimated complication of smoking. The take-home message includes:
· Smoking proved to have a negative impact on the hemodynamics of both normal kidney as well as kidney allograft and was correlated with the development of microalbuminuria and renal impairment.
· Smoking was associated with worse patient and allograft outcomes.
· Patients who quit smoking before transplantation had clear benefits regarding patient and graft survival compared to those who continue to smoke.
· Recipients of kidney allograft from a smoker living donor have a lower patient and allograft survival than recipients of kidney allograft from non-smoker donors.
· The development of a valid and accurate biomarker for tobacco smoking is essential as most of the studies rely on self-reporting of the participants, which may be inaccurate either due to recall errors or deliberately hiding the exact smoking habit for social reasons (e.g. in pregnant females).
· Cotinine (the major metabolite of nicotine) was introduced as a promising biomarker to evaluate the smoking dose. It has a longer half-life than nicotine (16 h vs 2-3 h for nicotine). However, it has its limitations as it can don’t differentiate ex-smokers from those who never smoke, it can not detect if the patient is occasionally smoking, and finally, it will miss the diagnosis of smokers who stopped smoking for the past few days only due to causes other than quitting smoking permanently (e.g. during an episode of illness).
Kidney allograft recipients are usually anxious regarding the allograft function, and they wish to preserve a well-functioning allograft for the longest possible time. Our approach is to ensure that the patient realised the fact that smoking will not only affect his survival, but it may end by losing his transplanted kidney sooner than expected; at that point, we have his full attention, and then we will refer him to smoking cessation activities which will help him during the journey to quit smoking.
Kidney donors will have the same increased risk of cardiovascular disease, pulmonary diseases, malignancy and death as the general population. Additionally, they will have a higher chance of deterioration of functions of the remaining kidney due to the augmentation of the physiological haemodynamic disturbance occurring in the remaining kidney during the compensation period after a sudden drop of GFR post-donation.
INTRODUCTION
Smoking is a challenging health care problem; it has a well-established correlation with many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death. Cigarette smoking assumes to have a role in atherosclerosis, endothelial dysfunction, progression of vascular disease and progression of proteinuria.
The effect of smoking is aggravated in renal transplant recipients due to the effect of immune suppression medications on carcinogenesis, in addition to the effect of chronic kidney disease itself on cardiovascular risk and mortality.
Effects of smoking on the kidney
The hazards of smoking were investigated thoroughly in association with cardiovascular disease, lung disease and oncogenesis. However, the effect of smoking on healthy kidney and progression of primary kidney diseases did not attract great attention.
Recipient smoking and transplantation outcome
Smoking is strongly correlated to some of the potentially fatal outcomes, and there is some evidence that these complications are aggravated in solid organ transplant recipients.
Smoking is a well-known risk factor for cardiovascular disease
The second leading cause of death post-transplantation was malignancy with a clear association between smoking and increased risk for certain types of malignancy.
Effect of smoking habit of kidney donor on the outcome of
Transplantation
It may be logic that the recipient smoking will affect his own survival, but surprisingly, even the donor smoking will affect the recipient survival years after transplantation.
Smoking biomarker and renal transplantation
Smoking exposure and analysis of dose of smoking depends on self-reporting in most of the studies. which we strongly believe it lacks accuracy. Proper estimation of the risks associated with tobacco use depends on accurate measurement of exposure, which may be difficult in certain population such as pregnant women and parents of young children, where smoking considered socially unaccepted. Some patients may not recall the number of cigarettes accurately (digit bias) and finally the tobacco dose differs between
individuals due to the difference between cigarettes as well as the difference in inhaling habits. Cotinine is the major metabolite of nicotine. It has a relatively constant level due its long half-life (16 h vs 2-3 h for nicotine), which can be measured in plasma
or urine. For these reasons, cotinine is considered a promising biomarker of smoking exposure. The use of cotinine also has its limitations. Cotinine level is a reflection of smoking over the past few days, and this may be misleading if the patient is smoking
occasionally (like in weekends) or if the patient was smoking less due to a period of illness. The second limitation lies in its inability to differentiate between never-smoking and former-smoking. We believe that the combination of cotinine measurement
and self-reporting of smoking exposure will be the most reliable approach in evaluating renal transplant population.
Level 4, review article.
By education about its effect on graft.
Smoking cessation clinics
Nicotine patch and gum.
Smoking and obesity reduced life expectancy and increased overall lifetime risks of ESRD in non-donors. However the percentage loss of remaining life years from donation was not very different in those with or without these risk factors.
Differences between postoperative complications were insignificant between smoking and nonsmoking donors . The most common complication was ileus at 6.73% in non-smoking donors and 5.13% in smoking donors. Surgical site infection, urinary retention, and urinary tract infection (UTI) were other common complications with rates under 5%.
References:
1-Clin Transplant 2014: 28: 419–422 DOI: 10.1111/ctr.12330
2-Kiberd BA, Tennankore KK. BMJ Open 2017;7:e016490. doi:10.1136/bmjopen-2017-016490
Introduction:
Smoking is a challenging health care problem.
Effects of smoking on kidney:
Many studies confirmed that smoking play role in progression of many intrinsic renal disease. Ritz et al found that there was increase in renal vascular resistance by 11% and a decrease in the GFR by 15%. Pinto Sietsma et al found a dose dependant association between smoking and development of both microalbuminuria and renal impairement.
Recipient smoking and transplant outcome:
Smoking is strongly correlated to some of the potentially fatal outcome.Ponticilli et al found that de novo development of cardiovascular insult in first year of post transplant has association with smoking.Post transplant malignancy has also association with smoking.
Most studies revealed a clear benefit of smoking cessation on graft survival.
Smoking biomartkers
Cotinine, a major metabolite of nicotine, which can be measured in plasma or urine, is a promising biomarkers of smoking expopsure, with some limitations.
Conclusion
Smoking remains a major modifiable health care challenge.
I will councell the patient regarding hazards of smoking and send them to smo9king cessation programme.
Effect of smoking on donor.
Causes decrease GFR and chances of cardiovascular morbidity and mortality and chance of malignency increas.
It is a Narrative Review – Level 5
This study exposes the role of smoking in kidney transplantation and its impact on the individual and the graft.
The absence of a long-term biomarker, the role of passive smoking, and the need for a well-taken anamnesis with robust data limits our knowledge of the impact and consumption of the individual, with smoking history being the pattern in the studies, making meta-analyses difficult.
In the general population, smoking brings a series of limitations, whether cardiovascular (atherosclerosis, peripheral arterial disease, venous insufficiency, deep vein thrombosis), pulmonary (chronic obstructive pulmonary disease, pulmonary emphysema, restrictive pattern, and limitation), neoplastic (various types of cancers). related, well beyond pulmonary, head and neck, skin, intestinal, etc.), nutritional, and genetic diseases (polycystic kidney, IgA nephropathy, diabetic nephropathy).
Associated with so many changes, some factors are specific to transplant patients. Intimate fibrous endothelial alterations, sclerosis nephropathy, and arteriolar hyalinosis are more frequent findings in smokers, with improvement in histopathological findings with smoking cessation. Drug interactions should also be considered, impacting the quality of immunosuppression and increasing the risk of graft rejection. There are even studies that report that smoking donors provide less effective grafts.
Perioperative and wound healing complications are much worse in smoking patients compared to the general population. Smoking cessation has several impacts on morbidity and mortality of both the donor and the recipient and the people around them.
There is a need for a multidisciplinary team, including psychologists and group care support, aiming at smoking cessation.
Association of smoking with cardiovascular and pulmonary disease, malignancy and mortality are well known. The renal effects of smoking are not well emphasized. Tobacco has pathological effects on native as well as graft kidneys, especially due to immunosuppression.
Smoking, through effects of nicotine, leads to increased arginine vasopressin, increased epinephrine, increased renal vascular resistance, microalbuminuria and reduced GFR. Smoking is associated with progression of renal diseases like diabetic nephropathy, IgA nephropathy and ADPKD. The cardiovascular insults seen in first year post-transplant are associated with a pre-existing cardiovascular disease, older age, hypertension, dialysis vintage and smoking. Smoking is also associated with increased risk of malignancies. A kidney biopsy in a current smoker reveals increased severity of vascular intimal fibrous thickening and the degree of chronic sclerosing nephropathy with arteriolar hyalinosis is more with increased duration of smoking time post-transplant.
Smoking has been shown to be associated with reduced patient and graft survival and its cessation improves graft survival, although there is no effect on the patient survival (due to underlying atherosclerosis). Smoking has been shown to be associated with increased risk of acute rejection. The GFR, graft and patient survival in a recipient of kidney from a smoker is lower than that from a non-smoker.
Cotinine is a metabolite of nicotine with increased half-life and potential to be used as biomarker of smoking exposure over past few days. Cotinine is not reliable if the smoking is occasional or curtailed during illness. So, combining self-reporting of smoking with serum cotinine levels would be helpful in evaluating transplant recipients.
Level of evidence: level 5 (narrative review)
Patients need to be counselled about the effect of smoking on their cardiovascular and pulmonary system, as well as its effects on the graft kidney. They should be encouraged to quit smoking at least 4 weeks prior to the transplant and it should be re-enforced on each OPD follow-up visit post-transplant. They may be referred for enrolment in smoking cessation programs utilizing behavioural and pharmacological therapies (nicotine patches, bupropion, varenicline and cytisine).
Smoking on a kidney donor has 2-fold effects.
Effects on the graft kidney from a smoker:
a) Reduced GFR
b) Reduced graft survival
c) Reduced patient survival
Effects on the donor:
a) Increased peri-operative complications
b) Increased chronic sclerosis nephropathy in the remaining kidney, having poor renal outcomes, fall in GFR leading to CKD later-on.
c) More post-operative wound infections
d) Increased mortality due to underlying atherosclerosis
e) Increased risk of malignancy, pulmonary disease, and cardiovascular disease
Smoking is well known modifiable risk factor for cardiovascular complications and mortality. Smoking is a preventable cause of death worldwide.
Smoking risk is attributed to its effect on vascular system by inducing or potentiation endothelial dysfunction, progression atherosclerosis and proteinuria, on top of cardiovascular side effects caused by immunosuupressive medications.
The effects of smoking on kidneys were addressed in many studies including transplant and non-transplant population.
In healthy volunteers smoking was associated with increase in serum arginine vasopression and increase in epinephrine level leading to intra-renal vasoconstriction with a subsequent reduction in GFR.
Smoking was also shown to be associated increased in albuminuria and abnormal renal function in non-diabetic patients.
In kidney transplant recipients smoking is a well-known risk factor for development of cardiovascular disease. It is also associated with de-novo cardiovascular disease in the first year post-transplantation.
Current smoking post transplantation have been linked to increased severity of vascular intimal fibrosis.
Few studies reported worse allograft survival in patients with tobacco use compared to non-smokers.
In conclusion ;
Smoking carried deleterious adverse events in patient with kidney transplantation. Current smokers at high risk of cardiovascular complications and graft loss.
What is the level of evidence provided by this article?
Level of evidence 5
How do you help renal transplant patients to stop smoking?
Smoking sessation is advised in the pre-transplant period during initial assessment. Smoking sessation is achieved via cognitive behavioral therapy in addition to pharmacological treatment.
Pharmacological treatment includes nicotine replacement drugs, Bupropion, varenicline and cytisine.
Summary:
INTRODUCTION:
Ø Smoking is a challenging health care problem; it has a well-established correlation with many severe medical conditions like cardiovascular diseases, pulmonary diseases, malignancy, and death. In addition, cigarette smoking assumes a role in atherosclerosis, endothelial dysfunction, and progression of vascular disease progression of proteinuria.
Ø The effect of smoking is aggravated in renal transplant recipients due to the development of immune suppression medications on carcinogenesis and the impact of chronic kidney disease on cardiovascular risk and mortality.
Ø The effect of smoking on the healthy kidney :
1. increase in arginine vasopressin levels
2. increase serum epinephrine
3. increase in renal vascular resistance by 11%
4. decrease in the glomerular filtration rate (GFR) by 15%.
Ø Recipient smoking and transplantation outcome:
· Smoking is a well-known risk factor for cardiovascular disease
· The development of de novo cardiovascular insult in the first year post-transplant
was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking, and duration of dialysis
· The second leading cause of death post-transplantation was malignancy. With a clear association between smoking and increased risk for certain types of
Malignancy
· Increase in the severity of vascular intimal fibrous thickening.
· The effect of smoking on renal transplant recipients was investigated in relatively few studies, most of which are retrospective. Table 1 summarises the result of most of these studies.file:///C:/Users/user/AppData/Local/Temp/msohtmlclip1/01/clip_image002.gif
Effect of the smoking habit of kidney donors on the outcome of transplantation:
Ø It may be logical that the recipient’s smoking will affect his survival, but surprisingly, even the donor
Ø smoking will affect the recipient’s survival years after transplantation
Ø they declared that the smoking habit of the donor has a mild yet statistically significant effect on recipient survival
Ø The impact of donor smoking on graft survival was statistically insignificant, unlike the recipient smoking, which proved to be significant
Ø the recipients of smoking donors had lower calculated GFR
Smoking biomarker and renal transplantation:
Ø Cotinine is the major metabolite of nicotine. In addition, it has a relatively constant level due to its long half-life (16 h vs. 2-3 h for nicotine), which can be measured in plasma or urine. For these reasons, cotinine is considered a promising biomarker of smoking exposure.
Ø The use of cotinine also has its limitations. Cotinine level is a reflection of smoking over the past few days. This may be misleading if the patient is smoking on weekends or if the patient was smoking less due to a period of illness.
Ø The second limitation lies in its inability to differentiate between never-smoking and former-smoking
Ø the level of evidence provided by this article: 1
Ø How do you help renal transplant patients to stop smoking:
Work up:
Cardiac evaluation
Vascular tree
Chest x-ray
PFT
CPET
Treatment: smoking cessation program and chest physiotherapy
ü What is the effect of smoking on kidney donors:
· Increase in arginine vasopressin levels
· Increase serum epinephrine
· Increase in renal vascular resistance by 11%
· Decrease in the glomerular filtration rate (GFR) by 15%.
V. Smoking in Renal Transplantation; Facts Beyond Myth
Briefly summarise this article
INTRODUCTION
– Smoking have a well-known correlation with CV diseases, pulmonary diseases, malignancy and death.
– Also may have a role in atherosclerosis, endothelial dysfunction, progression of vascular disease progression of proteinuria.
– This makes smoking a significant renal risk factor.
– Immune suppression medications aggravate the effect of smoking
**There are few studies for the effect of smoking on kidney transplant. Pinto-Sietsma et al perform a study to evaluate the effect of smoking on the development of albuminuria and abnormal kidney functions in non-diabetic population.
**There was a dose-dependent association between smoking and development of both microalbuminuria
**This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers.
Aim of the study: explore the effect of smoking on renal transplantation especially with smoking biomarker
Key words: Smoking; kidney donor; kidney recipient; Renal transplantation
EFFECTS OF SMOKING ON THE KIDNEY
-Ritz et al studied the effect of smoking on healthy normotensive volunteers.
-They reported a significant increase in arginine vasopressin levels and serum epinephrine.
-There was an increase in renal vascular resistance by 11% and a decrease in the GFR by 15%.
-They assumed these effects are secondary to nicotine itself as these findings were reproduced by using nicotine containing gum.
RECIPIENT SMOKING AND TRANSPLANTATION OUTCOME
-Smoking is a well-known risk factor for CV disease.
-The development of de novo cardiovascular insult in the first year post-transplant was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and duration of dialysis.
There is a clear association between smoking and increased risk for certain types of malignancy
– Most studies have revealed a clear benefit of smoking cessation on graft survival, but the effect on patient survival is less clear
EFFECT OF SMOKING HABIT OF KIDNEY DONOR ON THE OUTCOME Of TRANSPLANTATION
-Donor smoking also affect the recipient survival years after transplantation.
Lin et al have analysed data from the United Network for Organ Sharing from 1994 to 1999, and they declared that smoking habit of the donor has mild, yet statistically significant effect on recipient survival
Smoking biomarker and renal transplant
-A proper estimation of the risks associated with tobacco use depends on accurate measurement of exposure.
-Self-reporting estimation lacks accuracy (Some patients may not recall the number of cigarettes accurately; tobacco dose differs between individuals due to the difference between cigarettes).
-So development of a valid and accurate biomarker for tobacco smoking is importance
-Cotinine is the major metabolite of nicotine. It has a relatively constant level due its long half-life (16 h vs 2-3 h for nicotine), can be measured in plasma or urine.
– For these reasons, cotinine is considered a promising biomarker of smoking exposure.
**Hellemons et al studied 603 renal transplant recipients to investigate the relation of self-reporting and cotinine exposure and to evaluate the use of cotinine as an alternative for self- report.
-They concluded that active smoking had a negative impact on patient and graft survival, while former smokers had increased the risk of mortality but not graft failure.
– They documented that cotinine measurement (especially plasma cotinine) provides a valid alternative to self-reported smoking exposure, and it may even be preferred over self-reporting in epidemiological studies.
**Limitations of cotinine level: is a reflection of smoking over the past few days, and this may be misleading if the patient is smoking occasionally (like in weekends) or if the patient was smoking less due to a period of illness.
-The second limitation lies in its inability to differentiate between never-smoking and former-smoking.
-Differentiating never-smoking from former-smoking is clinically relevant as former-smoking was proved to be associated with increasing risk of recipient mortality
Combination of cotinine measurement and self-reporting of smoking exposure will be the most reliable approach in evaluating renal transplant population.
CONCLUSION
The use of smoking biomarkers proved to be reliable in evaluation and quantification of smoking exposure in the transplant population.
Donor smoking and recipient former smoking proved to have a negative impact on survival.
Transplant community should pay more attention to donor and recipient smoking cessation programs.
What is the level of evidence provided by this article?
The level of evidence V
How do you help renal transplant patients to stop smoking?
SMOKING CESSATION PROGRAMME : –
Offer a pluridisciplinary team, including doctors, nurses, social workers, psychologists and dieticians, who have access to drugs and medical facilities
First approach of SCPs is usually non-pharmaceutical, using behavioural, motivational and cognitive interviewing of the patient (counselling)
The 5As (ask, assess, advise, assist, and arrange follow-up) is the gold standard intervention and is efficient to increase the quitting rate
Ask: Systematically identify the smoking status at every visit
Advice: Provide a very brief, non-threatening recommendations to quit
Assess: Evaluate if the patient is ready to stop
Assist: Offer practical help for quitting
Arrange: Ensure the follow-up of the patient
PHARMACOLOGICAL :
-Nicotine replacement therapy (NRT) Bupropion*Nicotinic cholinergic receptor partial agonist: varenicline and cytosine.
What is the effect of smoking on kidney donors?
*Kidney donor smoking history negatively affects perioperative renal function
*Smoking history is associated with development of CKD after donation
*Longer pack-year history is associated with CKD, even in former smokers
*Smoking-cessation strategies should be implemented.
Many studies shows associated of smoking with CVD / pulmonary disease/ malignancy and death.
Smoking has role in atherosclerosis/ endothelial dysfunction/ progressive of vascular disease and progressive proteinuria.
Effects of smoking in renal transplant increase chance of carcinogenic in presence of immunosuppressive therapy and doubling risk of cardiovascular disease.
Effects of smoking in kidney:
Many studies shows progressive of intrinsic renal disease like diabetic nephropathy/ IgA nephropathy and ADPKD.
By using smoking shows increase of arginine vasopressin level and serum epinephrine and increase renal vascular resistance and decline of eGFR.
Recipient smoking and transplant outcome:
Smoking is well known risk factors of CVD.
Cardiovascular disease is leading cause of death in kidney transplant.
Development of de novo CVD is associated with old age/ pre transplant hypertension/ smoking and duration of dialysis.
Second leading cause of death post transplant was malignancy.
Current smoking has increase incidence of vascular intimal fibrous thickening.
Degree of chronic sclerosing nephropathy and arteriolar hyalinosis associated with duration of time post transplant.
Many studies shows effects of cessation of smoking on graft survival but patients survival is less obvious.
Effects of smoking habits of kidney donor on outcome of transplant.
Donor smoking also has effects on kidney transplant survival.
Smoking biomarker and renal transplant.
Cotinine is a bio markers of smoking exposure reliable in evaluation and quantity.
Limitations of cotinine is giving smoking exposure in past 5 days only.
It’s difficult to differentiate between never smoking and former smoking.
Combination of cotinine measurements is self reporting of smoking exposure.
It’s reliable approaches in evaluation renal transplant populations.
conclusion:
Smoking has adverse effects on recipient kidney transplant and smoking donor kidney reduce graft survival.
Risk of mortality increase in old age and DM, HTN and smoking.
Smoking cessation before transplant has improve graft survival and patients survival and reduce rate of malignancy.
Transplant community should be pay attention on donor and recipient for smoking cessation program.
Its increase graft loss in recipient transplant and associated with increase risk of cardiovascular disease and risk of malignancy
Briefly summarise this article
Smoking is a challenging health care problem; it has a well-established correlation with many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death. It is also identified as a significant renal risk.
The effect of smoking is aggravated in renal transplant recipients due to the effect of immune suppression medications on carcinogenesis, in addition to the effect of chronic kidney disease itself on cardiovascular risk and mortality.
Effects of smoking on the kidney
Many studies confirmed the role played by smoking in the progression of many intrinsic renal diseases (e.g., diabetic nephropathy, IgA nephropathy and autosomal dominant polycystic kidney disease).
A study by Ritz et al. showed increase in renal vascular resistance by 11% and a decrease in the glomerular filtration rate (GFR) by 15%. They assumed these effects are secondary to nicotine itself as these findings were reproduced by using nicotine containing gum. Another cross-sectional study by Pinto-Sietsma et al documented the presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment in this screening. These findings were less obvious or absent in former smokers.
Recipient smoking and transplantation outcome
Ponticelli et al have addressed the role of cardiovascular disease as the leading cause of death in renal transplant recipient. The development of de novo cardiovascular insult in the first-year post-transplant was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and duration of dialysis.
The second leading cause of death post-transplantation was malignancy with a clear association between smoking and increased risk for certain types of malignancy.
Several retrospective studies demonstrated the negative impact of smoking on graft survival as a well as patient’s survival and that smoking cessation has a clear benefit on graft survival.
Effect of smoking habit of kidney donor on the outcome of transplantation
Lin et al. found that smoking habit of the donor has mild, yet statistically significant effect on recipient survival. Another retrospective study found that the effect of donor smoking on graft survival was statistically insignificant, unlike the recipient smoking which proved to be significant. However, the recipient survival was negatively correlated to donor smoking and recipient smoking. Heldt et al found that the recipients of smoking donors had lower calculated GFR with a mean follow up of 38 months.
Smoking biomarker and renal transplantation
Self-reporting of smoking exposure has certain limitations; thus, it is important to search for a valid and accurate biomarker for tobacco smoking.
Cotinine is the major metabolite of nicotine. It has a relatively constant level due its long half-life (16 h vs 2-3 h for nicotine), which can be measured in plasma or urine. For these reasons, cotinine is considered a promising biomarker of smoking exposure.
Hellemons et al documented that cotinine measurement (especially plasma cotinine) provides a valid alternative to self-reported smoking exposure, and it may even be preferred over self-reporting in epidemiological studies. However, the use of cotinine also has its limitations. Cotinine level is a reflection of smoking over the past few days, and this may be misleading if the patient is smoking occasionally. It is also unable to differentiate between never-smoking and former-smoking. Therefore, a combination of cotinine measurement and self-reporting of smoking exposure could be the most reliable approach in evaluating renal transplant population.
What is the level of evidence provided by this article?
Level V. Evidence from systematic reviews of descriptive and qualitative studies (meta-synthesis).
How do you help renal transplant patients to stop smoking?
By smoking counselling and smoking cessation programs or application of Nicotine replacement therapy (NRT), Bupropion, Nicotinic cholinergic receptor partial agonist: varenicline and cytisine.
What is the effect of smoking on kidney donors?
Cigarette smoking in kidney donors is associated with higher rate of perioperative complications and postoperative wound infections. These donors are less likely to provide follow-up information requested by transplant centers [26]. There are mixed results for impact on graft function.
Reference:
Khalil MAM, Tan J, Khamis S, Khalil MA, Azmat R, Ullah AR. Cigarette Smoking and Its Hazards in Kidney Transplantation. Adv Med. 2017;2017:6213814. doi: 10.1155/2017/6213814. Epub 2017 Jul 27. PMID: 28819637; PMCID: PMC5551477.
Donors with a smoking history require close observation due to increased risk of CKD development after kidney donation.
Reference:
Y.E. Yoon, H.H. Lee, J.C. Na, K.H. Huh, M.S. Kim, S.I. Kim, Y.S. Kim, W.K. Han,Impact of Cigarette Smoking on Living Kidney Donors,Transplantation Proceedings, Volume 50, Issue 4, 2018, Pages 1029-1033, ISSN 0041-1345, https://doi.org/10.1016/j.transproceed.2018.02.050.
Kauffman-Ortega C, Martínez-Delgado GH, Garza-Gangemi AM, Oropeza-Aguilar M, Gabilondo-Pliego B, Gabilondo-Navarro F, Rodríguez-Covarrubias F. Short-and Mid-Term Impact of Tobacco Smoking on Donor Renal Function Following Living Kidney Donation at a Tertiary Referral Hospital. Revista de investigación clínica. 2021 Aug;73(4):238-44.
Summary:
Smoking in Renal Transplantation; Facts Beyond Myth
Introduction
The effect of smoking is more obvious on the renal allograft most probably due to the chronic immune suppression status and the metabolic effect of the drugs. In addition to the effect of CKD itself on cardiovascular risk and mortality.
Effeccts of smoking on the kidney:
– Many studies confrmed the role played by smoking in the progression of many intrinsic renal diseases.
– Smoking increase renal vascular resistance and decrease GFR
– Presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment was documented.
Recipient smoking and transplantation outcome
– Smoking is associated with lowering patient and graft survival.
– Even receiving a renal transplant from a smoker donor increases the risk of death for the recipient and carries a poorer graft survival compared to non-smoking donors.
– Smoking is correlated to fatal outcomes which are aggravated in solid organ transplant recrecipients.
– Most of studies have revealed a clear beneft of smoking cessation on graft survival, but the effect on patient survival is less clear possibly reflecting the permanent atherosclerotic effect on the vascular system.
Effect of smoking habit of kidney donor on the outcome of transplantation
The donor smoking will not affect graft survival but it can affect the recipient survival years after transplantation.
Smoking biomarker and renal transplantation
– Cotinine which is the major metabolite of nicotine is a promising biomarker of smoking exposure.
– Combination of cotinine measurement and self-reporting of smoking exposure is the most reliable approach in evaluating renal transplant population.
▪︎What is the level of evidence provided by this article? Level 5
▪︎How do you help renal transplant patients to stop smoking?
I will consult him about the adverse effects of smoking on graft survival and patient mortality and the importance of smoking cessation, and I will send him to a psychologist to help him to stop smoking. ▪︎What is the effect of smoking on kidney donors?
Smoking in kidney donors is associated with higher rate of perioperative complications and post operative wound infection.
Smoking is one of the preventable leading causes of death worldwide.
Smoking is a challenging health care problem; it has a well-established correlation with many serious medical conditions like cardiovascular diseases, pulmonary diseases, malignancy and death
There are emerging evidence correlating tobacco use with pathological changes in the normal kidneys. The effect is more obvious on the renal allograft most probably due to the chronic immune suppression status and the metabolic effect of the drugs.
Cigarette smoking assumes to have a role in atherosclerosis, endothelial dysfunction, progression of vascular disease progression of proteinuria, as it contains large amounts of free radicals. This makes smoking a significant renal risk factor, with considerable consequences on health care budget.
Studies documented the presence of a dose-dependent association between smoking and development of both microalbuminuria and renal impairment
Most of these studies have revealed a clear benefit of smoking cessation on graft survival, but the effect on patient survival is less clear possibly reflecting the permanent atherosclerotic effect on the vascular system.
One of the studies shows that Smoking was associated with
more often vascular fibrous intimal thickening in smokers compared to non-smokers so that it may have a role in the development of chronic allograft nephropathy and graft loss.
History of smoking will negatively
affect patient and graft survival. Also, it increases the risk of early rejection
However, the recipient survival was negatively correlated to donor smoking and recipient smoking
Cotinine is the major metabolite of nicotine. It has a relatively constant level due its long half-life (16 h vs 2-3 h for nicotine), which can be measured in plasma or urine.
We believe that the combination of cotinine measurement and self-reporting of smoking exposure will be the most reliable approach in evaluating renal transplant population.
CONClUsION
Smoking remains a major modifiable health care challenge; it is the leading cause of variable morbidities and mortality. The use of smoking biomarkers proved to be reliable in evaluation and quantification of smoking exposure in the transplant population. Donor smoking and recipient former smoking proved to have a negative impact on survival. Transplant community should pay more attention to donor and recipient smoking cessation programs.
What is the level of evidence provided by this article?
Level V
How do you help renal transplant patients to stop smoking?
Patient education about disadvantages and side effect of smoking
Psychiatrist help and referral to smoking session program
using nicotine containing gum and other modalities that help in smoking sensation
On donor it will affect on his cardiovascular system,respiratory
Briefly summarise this article:
as all of us knows smoker is one of the most important risk factor for CVD , Respiratory disease , Infection , malignancy , on the other hand transplantation and suppression medication increase all the mentioned risk factor so the transplantation with smoking associated with high rate of mortality and morbidity and negative impact on allograft survival .
smoking can affect renal system by many mechanism
the effect on renal transplantation
The studies show clear benefit of cessation on graft survival but not patient survival.
In smoker donors some studies highlights deleterious effect in recipient survival, decreased GFR post transplant, and graft survival as well.
Cotinine is a nicotine metabolite with log half life of 16 hrs, a biomarker of smoking exposure, measured in plasma and urine, used in many studies and assures the negative effect of active smoking on patient and graft survival, and ex-smoking had increased risk of mortality but not affect graft survival. Cons of this biomarker is it could be high in occasional smokers, passive smokers , cannot differentiate never smoke and former smoker, so detailed smoking history and this biomarker can be a reliable approach in evaluating renal transplant population
What is the level of evidence provided by this article?
level of evidence V
How do you help renal transplant patients to stop smoking?
What is the effect of smoking on kidney donors?
Briefly summarise this article
Smoking is associated with increased risk of cardiovascular disease, pulmonary pathologies and higher cancer risks. This increases the morbidity and mortality.
It has now been proved that smoking has significant effects on renal graft and can affect graft outcomes.
Stopping smoking before transplant is recommended and may improve overall outcomes. The effect on graft can be due to chronic immune suppression. EX smokers ay have greater mortality but not much effect on graft.
Overall it has negative impact on graft as it can lead to endothelia injury, atherosclerosis, progression of vascular insult and proteinuria.
Smoking increases vascular resistance and decreases GFR. It can increase microalbuminuria and can cause progression of hematuria.
Cotinine can be used as a marker of smoking status exposure to nicotine.
Effects on renal transplant recipient are significant and include.
Microalbuminuria and development of renal failure
Increased vascular resistance
Decreased GFR
Progression diabetic or IgA nephropathy
Higher risk of malignancy
Increased risk of CVD and pulmonary disease
What is the level of evidence provided by this article?
Level V review article
How do you help renal transplant patients to stop smoking?
Patient education and counselling
Use nicotine gums and patches
Referral to smoking cessation programme
What is the effect of smoking on kidney donors?
High risk of peri operative complications
High risk of respiratory complications
High risk f wound dehiscence
Secondary polycythemia.
Briefly summarise this article
Smoking is associated with serious medical conditions like;
– cardiovascular diseases
-pulmonary diseases
-malignancy
-death.
Smoking has a significant renal risk factor, with considerable consequences on health care budget and this may be due to;
– its role in atherosclerosis
– It causes endothelial dysfunction
– Its role in progression of proteinuria .
There are emerging evidence correlating tobacco use with pathological changes in
the normal kidneys.
Many studies confirmed the role played by smoking in the progression of many intrinsic renal diseases (e.g., diabetic nephropathy, IgA nephropathy and autosomal
dominant polycystic kidney disease).
The effect is more obvious on the renal allograft most probably due to the chronic immune suppression status and the metabolic effect of the drugs.
Cotinine was proposed as a promising biomarker that may help to provide objective evidence regarding the status of smoking and the dose of nicotine exposure, yet there are still some limitations of its use.
Recipient smoking and transplantation outcome ;
Smoking is strongly correlated to some of the potentially fatal outcomes, and there is some evidence that these complications are aggravated in solid organ transplant
recipients.
.
Smoking is a well-known risk factor for cardiovascular disease.
The development of de novo cardiovascular insult in the first year post-transplant
was associated with pre-existing cardiovascular disease, older age, pre-transplant hypertension, smoking and duration of dialysis.
The second leading cause of death post-transplantation was malignancy
with a clear association between smoking and increased risk for certain types of
malignancy.
.
Most of these studies have revealed a clear benefit of smoking cessation on graft survival, but the effect on patient survival is less clear possibly reflecting the permanent atherosclerotic effect on the vascular system.
It may be logic that the recipient smoking will affect his own survival, but surprisingly, even the donor smoking will affect the recipient survival years after transplantation.
Several studies have documented a deleterious effect of smoking on the renal transplant recipients.
Smoking was associated with lowering patient and graft survival. Smoking cessation proved to improve graft survival and to a lesser extent recipient survival.
Even receiving a renal transplant from a smoker donor increases the risk of death for the recipient and carries a poorer graft survival compared to non-smoking donors.
What is the level of evidence provided by this article?
Level V
How do you help renal transplant patients to stop smoking?
1-The smoking status of every KT candidate or recipient should be assessed at every appointment.
2-An SCP is offered to every smoking patient.
The first approach of SCPs is usually non-pharmaceutical, using behavioural, motivational and cognitive interviewing of the patient (counselling).
Then a pharmaceutical approach is generally proposed and must be adapted to the patient’s medical history and expectations.
What is the effect of smoking on kidney donors?
Lin et al declared that ,smoking habit of the donor has mild, yet statistically significant effect on recipient survival .
Underwood et al studied a retrospective analysis of 602 kidney transplant recipients and their living donors .The effect of donor smoking on graft survival was statistically insignificant . Unlike the recipient smoking which proved to be significant. The recipient survival was negatively correlated to donor smoking.
Heldt et al evaluated GFR of 100 living donors and their recipients, found that ,the recipients of smoking donors had lower calculated GFR .
.
Smoking is the one of the preventable leading cause of death worldwide, many studies focus on smoking effect on cardiovascular , chest, malignancy and death .
In general , effect of smoking on kidney, involve its effect on vascular system (atherosclerosis), endothelial dysfunction, progression of vascular disease, and proteinurea, as the effects of free radicals, those effects additionally augmented in transplat recipient by effect on immunosuupressant medications, and effect of CKD on cardiovascular risk of mortality.
Effect of smoking on kidneys:
Ritz et al. ;
study show the effect of smoking on health normotensive volunteers, show that increase arginine vasopression, level from ( 1.27 +/- 0.72 to 19.9+/-27.2), and increase in epinephrine level from (37+/-13 to 140) , and increase in vascular resistance by 11%, and decrease in GFR by 15%, all as a result on nicotine.
Pinto–Sietsma et al. :
cross-sectional study, involve 7476 participants, study the effect of smoking in microalbuminurea, and abnormal renal function, in non-diabetic population.
they document the presence of dose dependant association between smoking and development of both micro albuminurea, and renal impairment, these finding were less obvious in former smokers.
Recipient smoking and kidney transplant outcome;
Smoking are well known risk factor for development of cardiovascular disease.
Ponticelli et al. ; adressed the role of CVD as a leading cause of death in transplant recipients, also development of Denovo cardiovascular insult in the first year post-transplant, and association between pre-transplnt CVD, older age, pre-existing HTN, smoking, and duration of dialysis.
The second leading cause of death post transplant is malignancy and the association between malignancy and smokin.
Zitt et al.:
study realtion between smoking and renal biopsy, for 76 transplant kidneys , found that current smoker have increase severity of vascular imtimal fibrosis thickness with P value of 0.004.
The following studies show that the effects of smoking on kidney transplant;
Conclusion ;
smoking is the major modifiable health care challenge, and a leading cause of variable comorbidities and mortality.
we can help potentail recipient to stop smoking by proper councelling about the risk of smoking with detailed mensioned in this article, and also reffer him to smoking clinic, who design program for such patients.
Smoking is a risk factor for CVD, pulmonary disease, malignancy and death. It has a negative impact on kidney function. Kidney transplant recipients are at more risk due to the use of immunosuppressants with its carcinogenic effect and CKD itself which is a risk factor for CVD.
Data about the effect of smoking on kidney transplant population is insufficient.
Effect of smoking on the kidney:
It accelerate the progression of many renal diseases as diabetic nephropathy, IgA nephropathy and ADPKD
It increase renal vascular resistance and decrease GFR in healthy people and was associated with development of microalbuminuria and impaired kidney function during screening in non-diabetic population
Recipient smoking and transplant outcome:
The adverse effects of smoking are more prominent in transplant patients.
Smoking is one of the main risk factors for CVD, the leading cause of death in kidney transplant recipients.
It is associated with increased risk of certain malignancies, the second leading cause of death post transplant.
A study showed that kidney recipients who were current smokers had more severe vascular intimal fibrous thickening than nonsmokers.
Several studies showed that cessation of smoking improved graft survival but had no effect on patient survival mostly due to the permanent atherosclerotic effect of smoking.
Effect of smoking habit of donor on outcome of transplant:
Donor smoking affects recipient survival even years post transplant.
A study showed that smoking habit of donor had a mild but significant effect on recipient and graft survival.
Other retrospective study showed insignificant effect on graft survival but with negative correlation between recipient survival and donor smoking
Recipients of smoking donors had lower GFR during follow up.
Smoking biomarker and renal transplantation:
Accurate analysis of dose of smoking is difficult as it depends on self reporting which may be misleading due to social causes, may not be recalled accurately, different tobacco doses in different cigarettes and different inhaling habits.
Cotinine is a promising biomarker of smoking exposure, can be measured in plasma or urine.
It can be used as alternative to self reported smoking exposure and is preferred in epidemiological studies.
It has some limitations as it reflects smoking over past days only and can’t differentiate between never smoking and former smoking, former smoking is associated with increased risk of recipient mortality.
Combination of cotinine level and self reporting of smoking is the most reliable approach to evaluate kidney transplant population.
Level 5, review article
Counselling them about the risks of smoking and its adverse effects.
encouraging them to join smoking cessation programs.
Kidney donors who smoke have higher rate of perioperative complications and are at increased risk of wound and chest infections.(1)
Donors who actively smoke or were former smokers had higher serum creatinine than non smokers one year after donation.(1)
Amsterdam Forum guidelines recommend cessation of smoking 6 weeks before kidney donation.(1)
(1)Khalil MA, Tan J, Khamis S, Khalil MA, Azmat R, Ullah AR. Cigarette smoking and its hazards in kidney transplantation. Advances in Medicine. 2017 Jul 27;2017.