Kidney disease is a non-communicable disease (NCD) and currently affects around 850 million people worldwide. One in ten adults suffers from chronic kidney disease (CKD). The global burden of CKD is increasing and CKD is projected to become the 5th most common cause of years of life lost globally by 2040. The true burden of end-stage kidney disease (ESKD) in India is not known, with few dedicated centers for the care of such patients, a lack of universal access to renal replacement therapy (RRT), and the absence of a national registry. In the absence of universal government funding like in the USA and UK, the cost of dialysis and kidney transplant is borne by the patient’s family pushing many of them into debt. It remains beyond the reach of the vast majority
There is an unequivocal role of smoking on the rising incidence and progression of CKD, irrespective of the original kidney disease. Cigarette Smoking is the best poison for patients with kidney diseases. The risk of developing CKD decreases with the time elapsing after smoking cessation or increases with cumulative exposure, which suggests a dose-dependency of the cause-effect relationship. If we look at a summary of all scientific studies done so far on smoking in regards to kidney ailments, the relative risk for developing CKD was 27 times higher and for end-stage renal disease 51 times higher for the person who has used to smoke but has quit smoking later. For those who continued smoking the risks were even higher: 34 times for CKD and 91 times higher for end-stage renal disease. The negative impact of smoking also exponentially contributes to cardiovascular risk in patients with CKD, adding further insult to the injury. In a recent Japanese study conducted on more than 35, 000 people, smoking were associated with a much higher risk for overall cardiac mortality. Smoking slows the blood flow to important organs like the kidneys and can make kidney disease worse. The risk continues even after transplant and tobacco exposure is associated with a 1.5 to 7.5 time’s lower patient survival and 1.5 to 8.0 times lower kidney survival and smoking cessation is associated with improvements in patient and kidney survival. In recent years, rather consistent findings from animal models and in vitro studies can help us to decipher why smoking could harm the kidneys. Consumption of nicotine causes narrowing of blood vessels, resulting in a transient rise in blood pressure and a decrease of glomerular filtration rate and renal blood flow after exposure in healthy adults Thus, smoking promotes the development of kidney fibrosis, leading to a faster decline of kidney function. Recent Exposure to cigarette smoke accelerated tissue kidney injury with increased expression of molecular fibrosis -markers of fibrosis.
The author is Principal Director, Nephrology and Kidney Transplant, Fortis Hospital Vasant Kunj.