Evidence map›Paper›PMID 27118687›Full record

Observational studyAmerican journal of kidney diseases : the official journal of the National Kidney Foundation2016

Smoking and Adverse Outcomes in Patients With CKD: The Study of Heart and Renal Protection (SHARP).

Natalie Staplin, Richard Haynes, William G Herrington, Christina Reith, Alan Cass, Bengt Fellström, Lixin Jiang, Bertram L Kasiske, Vera Krane, Adeera Levin and 7 more

Open access · hybridAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in American journal of kidney diseases : the official journal of the National Kidney Foundation, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
41citing papers in PubMed, 1 pooled it
6.9field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

41 citing papers in PubMed, 1 synthesis or guideline pooled it, 83 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
  4. The Role of Precision Nutrition in Kidney Disease.Clinical journal of the American Society of Nephrology : CJASN · 2026
    Review
  5. Article
  6. Review
  7. Article
  8. Article
  9. Observational
  10. Review
  11. Article
  12. Article
  13. Article
  14. Review
  15. Framework of Guidelines for Management of CKD in Asia.Kidney international reports · 2024
    Article
  16. Review
  17. Article
  18. Article
  19. Article
  20. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors at 8 institutions in 7 countries.

Natalie StaplinClinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
Richard HaynesClinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
William G HerringtonClinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
Christina ReithClinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
Alan CassMenzies Institute, Darwin, Australia.
Bengt FellströmUniversity Hospital, Uppsala, Sweden.
Lixin JiangChina Oxford Centre for International Health Research, Fuwai Hospital, Beijing, China.
Bertram L KasiskeUniversity of Minnesota, Minneapolis, MN.
Vera KraneDivision of Nephrology, University of Wuerzberg, Wuerzberg, Germany.
Adeera LevinUniversity of British Columbia, Vancouver, BC, Canada.
Robert WalkerUniversity of Otago, Dunedin, New Zealand.
Christoph WannerDivision of Nephrology, University of Wuerzberg, Wuerzberg, Germany.
David C WheelerUniversity College London, London, United Kingdom.
Martin J LandrayClinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
Colin BaigentClinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom. Electronic address: colin.baigent@ctsu.ox.ac.uk.
Jonathan EmbersonClinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom. Electronic address: jonathan.emberson@ctsu.ox.ac.uk.
SHARP Collaborative Group
University of Oxford · GBUniversity College London · GBMenzies School of Health Research · AUChinese Academy of Medical Sciences & Peking Union Medical College · CNUniversity of British Columbia · CAUniversity of Minnesota · USUniversity of Otago · NZUppsala University Hospital · SE

Funding

Medical Research Council MC_U137686849Medical Research Council MC_U137686860Medical Research Council MC_UU_12026/5
6 · The paper itself

Abstract

backgroundThe absolute and relative importance of smoking to vascular and nonvascular outcomes in people with chronic kidney disease (CKD), as well its relevance to kidney disease progression, is uncertain. STUDY

designObservational study. SETTING &

participants9,270 participants with CKD enrolled in SHARP. PREDICTOR: Baseline smoking status (current, former, and never). OUTCOMES: Vascular events, site-specific cancer, ESRD, rate of change in estimated glomerular filtration rate (eGFR), and cause-specific mortality.

resultsAt baseline, 1,243 (13%) participants were current smokers (median consumption, 10 cigarettes/day); 3,272 (35%), former smokers; and 4,755 (51%), never smokers. Median follow-up was 4.9 years. Vascular event rates were 36% higher for current than never smokers (2,317 events; relative risk [RR], 1.36; 95% CI, 1.19-1.55), reflecting increases in both atherosclerotic (RR, 1.49; 95% CI, 1.26-1.76) and nonatherosclerotic (RR, 1.25; 95% CI, 1.05-1.50) events. Cancer was 37% higher among current smokers (632 events; RR, 1.37; 95% CI, 1.07-1.76), with the biggest RRs for lung (RR, 9.31; 95% CI, 4.37-19.83) and upper aerodigestive tract (RR, 4.87; 95% CI, 2.10-11.32) cancers. For 6,245 patients not receiving dialysis at baseline, ESRD incidence did not differ significantly between current and never smokers (2,141 events; RR, 1.02; 95% CI, 0.89-1.17), nor did estimated rate of change in eGFR (current smokers, -1.77±0.14 [SE]; never smokers, -1.70±0.07mL/min/1.73m(2) per year). All-cause mortality was 48% higher among current smokers (2,257 events; RR, 1.48; 95% CI, 1.30-1.70), with significant increases in vascular (RR, 1.35; 95% CI, 1.07-1.69) and nonvascular (RR, 1.60; 95% CI, 1.34-1.91) causes of death, especially cancer (RR, 2.32; 95% CI, 1.58-3.40) and respiratory (RR, 2.25; 95% CI, 1.51-3.35) mortality. LIMITATIONS: Smoking status not assessed during follow-up.

conclusionsIn this study of patients with CKD, smoking significantly increased the risks for vascular and nonvascular morbidity and mortality, but was not associated with kidney disease progression. The associations with vascular and neoplastic disease are in keeping with those observed in the general population and are likely modifiable by cessation.

Indexed as

Cardiovascular DiseasesDisease ProgressionFemaleHeart DiseasesHumansKidney Failure, ChronicMaleMiddle AgedProspective StudiesRenal Insufficiency, ChronicSmokingcancercause-specific mortalitychronic kidney disease (CKD)Cigarette smokingdisease progressionend-stage renal disease (ESRD)estimated glomerular filtration rate (eGFR)risk factorStudy of Heart and Renal Protection (SHARP)tobaccovascular eventsvascular morbidity

Identifiers

PMID27118687
PMCPMC4996629
OpenAlexW2340386927

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.