#1164 Smoking cessation and atherosclerotic cardiovascular events and mortality in chronic kidney disease

Abstract

Abstract Background and Aims Smoking cessation is recommended to reduce excess atherosclerotic cardiovascular disease (ASCVD) and mortality in patients with chronic kidney disease (CKD). However, this recommendation is largely based on observational studies on the general population, involving participants with preserved kidney function. Therefore, we aimed to evaluate the association of smoking dose and smoking cessation duration with ASCVD and mortality in patients with CKD. Method We compiled a comprehensive pooled dataset comprising 66,245 participants with CKD from the KNOW-CKD and the UK Biobank cohort. Participants were categorized according to smoking dose and duration of smoking cessation base on a questionnaire. The primary outcome encompassed a composite of ASCVD or all-cause mortality. An ASCVD event was defined according to the ICD-10 codes in the claim and death register records. Results Over a median follow-up period of 13.2 years, 14,671 (22.1%) participants reached the primary outcome. Compared to never smokers, former and current smokers exhibited a 1.30- and 2.14-fold higher risk of the primary outcome, respectively. Among former smokers, the hazard ratios (HRs) (95% confidence intervals [CIs]) for smoking loads <20 and ≥20 pack-years were 1.05 (1.00–1.10) and 2.14 (2.05–2.25), respectively. The increased risk of the primary outcome was attenuated by longer smoking cessation. The HRs (95% CIs) for smoking cessation of <10 years, 10–20 years, and >20 years were 1.75 (1.65–1.86), 1.43 (1.34–1.52), and 1.11 (1.06-1.16), respectively, compared with never smokers. Conclusion Among former smokers with CKD, the risk of ASCVD or mortality was substantially attenuated with less smoking load and a longer duration of smoking cessation. Our findings support the preexisting recommendations for smoking cessation to improve clinical outcomes in patients with CKD.