INFLUENCE OF SMOKING ON THE SURVIVAL RATE OF DIABETIC-PATIENTS REQUIRING HEMODIALYSIS

OBJECTIVE - To study the influence of cigarette smoking on the surviva l rare of diabetic patients on hemodialysis. RESEARCH DESIGN AND METHO DS - We evaluated 1- and 5-year survival rates and the mean values of HbA(1c), serum lipids, fibrinogen, and blood pressure. We compared the prevalence of vascular damage at the beginning of dialysis therapy an d the endpoint of the study, as well as the causes of death in 22 diab etic patients who smelted (>10 cigarettes/day) and 30 nonsmoking diabe tic patients. RESULTS - There were no differences with respect to HbA( 1c), cholesterol, and triglycerides. In contrast, diabetic patients wi th tobacco consumption had significantly (P < 0.05) higher levels of f ibrinogen (428 +/- 98 vs. 378 +/- 76 mg/dl) and higher systolic blood pressures (154 +/- 12 vs. 146 +/- 13 mmHg) 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%, respectiv ely (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 patien ts (77 vs. 13%). Cardiovascular events were the most frequent cause of death in both patient groups but more frequently in the smoking subje cts (80 vs. 63%). CONCLUSIONS - Hemodialyzed diabetic cigarette smoker s show higher fibrinogen and systolic blood pressure values, a higher incidence of myocardial infarctions, and their 5-year survival rare is significantly decreased when compared with nonsmoking patients on hem odialysis.