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Smoking: A Risk Factor for Progression of Chronic Kidney Disease and for Cardiovascular Morbidity and Mortality in Renal Patients—Absence of Evidence or Evidence of Absence?

Stephan R. Orth^*, and Stein I. Hallan

^* Dialysis Center Bad Aibling, Bad Aibling, and Department of Internal Medicine II, University of Regensburg, Regensburg, Germany; and Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, and Department of Medicine, Division of Nephrology, St. Olav University Hospital, Trondheim, Norway

Correspondence: Dr. Stephan R. Orth, Bahnhofstrasse 9, D-83043 Bad Aibling, Germany. Phone: 0049-170-2311948; Fax: 0049-08061-37925; E-mail: stephan.orth{at}gmx.net

Although it is beyond any doubt that smoking is the number one preventable cause of death in most countries, smoking as an independent progression factor in renal disease has been questioned against the background of evidence-based criteria. This is because information from large, randomized, prospective studies that investigate the effects of smoking on renal function in healthy individuals as well as in patients with primary or secondary renal disease are lacking. Since 2003, a substantial number of clinical and experimental data concerning the adverse renal effects of smoking have been published, including large, prospective, population-based, observational studies. These more recent data together with evidence from experimental studies clearly indicate that smoking is a relevant risk factor, conferring a substantial increase in risk for renal function deterioration. This review summarizes the present knowledge about the renal risks of smoking as well as the increased cardiovascular risk caused by smoking in patients with chronic kidney disease. The conclusion is that smoking is an important renal risk factor, and nephrologists have to invest more efforts to motivate patients to stop smoking.

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