How does smoking affect kidney disease?
Kidney disease is an example of vascular disease. Tobacco, like the other so-called classic cardiovascular risk factors, i.e., hypertension, diabetes, hypercholesterolemia and obesity, should be treated vigorously, i.e., it is a factor that is directly related to the possibility of developing vascular diseases and logically within them renal diseases. Therefore, we must be very vigilant to ensure that each and every one of the risk factors is controlled and to avoid the so-called therapeutic diagnostic inertia. We are all very clear that our blood pressure, our glucose levels, our cholesterol control in the analytical analysis is important and we leave the issue of lifestyle habits for last. Well, smoking, tobacco consumption, is so harmful that I would put it even before the rest of the risk factors.
Tobacco and kidney transplantation What happens?
The kidney transplant patient is a very special patient because of many conditions. Firstly, because it is a patient with chronic kidney disease who has undergone the most important therapy for chronic kidney disease, which is kidney transplantation. Therefore, he is a patient who must be extremely careful in each of the risk factors. And there is no doubt, smoking induces damage in a patient who also has only one functioning kidney and must be cared for like “gold in a china shop”. Moreover, in the case of smoking, if the technique and strategy is correct, success is very high. And we have a special conditioning factor in the kidney transplant patient, because he is taking a lot of medication, he is a polymedicated patient and some of the drugs may have interactions with others. If our kidney transplant patient requires specific therapy for smoking, the nephrologist must be very vigilant in monitoring the possible side effects of smoking cessation medication in relation to immunosuppressants or other drugs that our kidney transplant patient may receive. Therefore, it is not contraindicated, far from it, but it does require very close monitoring.
What is the best strategy for smoking cessation?
In my case, I offer a multidisciplinary approach to smoking cessation, that is, it is very important that the smoking patient is approached together with the rest of the cardiovascular risk factors they present. That is to say, we should not abandon other medications or forget other side effects that may be related to our patient. That is to say, as with all smokers, we are going to assess their physical and psychological dependence and their degree of motivation, but if it is necessary to start a program, we are going to offer them a multidisciplinary program and an individualized program, as it cannot be otherwise, more than anything else because it is the most effective. In any case, from the consultation, as the coordinating physician, what I am going to take you through is different techniques: genetic, radiological, something very important is the issue of nutrition. Through a bioimpedanciometry we will see the degree of lean mass, fat and water, that is to say, of hydration that our patient has, because it is not impossible to stop smoking without putting on weight; that is to say, we are going to get the weight to stabilize. Some laboratory tests, essential analytical tests to check the side effects of the medication, respiratory tests, as is logical, and peripheral vascularization tests such as the ankle-brachial index. But most important of all, we have a follow-up program, that is to say, the patient has constant contact with the doctor to tell him if he has side effects, if he is feeling unwell, if he is unmotivated, if he has a problem of dependence or the need to consume, because this can be achieved as long as the contact is very close. And that is what the program is designed for and the success rate is, fortunately, very high.