Influence of Smoking on the Survival Rate of Diabetic Patients Requiring Hemodialysis

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Abstract
OBJECTIVE To study the influence of cigarette smoking on the survival rate of diabetic patients on hemodialysis. RESEARCH DESIGN AND METHODS We evaluated 1- and 5-year survival rates and the mean values of HbA1c, serum lipids, fibrinogen, and blood pressure. We compared the prevalence of vascular damage at the beginning of dialysis therapy and the endpoint of the study, as well as the causes of death in 22 diabetic patients who smoked (> 10 cigarettes/day) and 30 nonsmoking diabetic patients. RESULTS There were no differences with respect to HbA1c, cholesterol, and triglycerides. In contrast, diabetic patients with tobacco consumption had significantly (P < 0.05) higher levels of fibrinogen (428 ± 98 vs. 378 ± 76 mg/dl) and higher systolic blood pressures (154 ± 12 vs. 146 ± 13 mm Hg) than the nonsmoking group. The 1- and 5-year survival rates of the smoking patients were 68 and 9%, respectively, and in the nonsmoking subjects, 80 and 37%, respectively (P < 0.05). The prevalence of vascular damage was similar in both groups, but at the endpoint of the study, the incidence of myocardial infarctions was significantly higher (P < 0.005) in the smoking patients (77 vs. 13%). Cardiovascular events were the most frequent cause of death in both patient groups but more frequently in the smoking subjects (80 vs. 63%). CONCLUSIONS Hemodialyzed diabetic cigarette smokers show higher fibrinogen and systolic blood pressure values, a higher incidence of myocardial infarctions, and their 5-year survival rate is significantly decreased when compared with nonsmoking patients on hemodialysis.

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