Jason S Brody, Wei Wang, Robert W Schrier and Berenice Reed-Gitomer
Background: Cardiovascular disease is the leading cause of death among patients with autosomal dominant polycystic kidney disease (ADPKD). Smoking increases inflammation and contributes to cardiovascular disease in the general population. The purpose of this study was to determine the effects of smoking on health outcomes in patients with ADPKD. Methods: The study population included 350 smoking and 371 non-smoking ADPKD patients who participated in studies at the University of Colorado between 1985 and 2001. In addition, outcome data collected between 2011 and 2012 by survey from 159 smoking and 259 non-smoking ADPKD patients was analyzed. The frequency of cardiovascular or cerebrovascular events, age at onset of end stage renal disease, and serum and urine chemistries where available were compared in smoking and non-smoking patients. Serum levels of soluble CD40 ligand measured by ELISA were analyzed in a sub-set of 40 patients matched by age, sex, and renal function. Results: ADPKD smokers from the University of Colorado study cohort had more cardiovascular events and higher urinary protein excretion than ADPKD non-smokers. The ADPKD survey respondents had a higher rate of cerebrovascular events in patients who smoked. Smoking years were associated with increased odds of having a cerebrovascular event. Serum soluble CD40 ligand level was higher in ADPKD patients who smoked compared to non-smoking patients (5293 ± 3168 vs. 3285 ± 2169 pg/mL, P=0.025) indicative of increased inflammation. Conclusions: ADPKD patients who smoke have a higher hazard for cardiovascular and cerebrovascular events and evidence for increased inflammation.