How does tobacco affect kidney disease?
Renal diseases are an example of vascular disease. Tobacco, like the other classic cardiovascular risk factors, that is, hypertension, diabetes, hypercholesterolemia and obesity, must be treated vigorously, that is, it is a factor that is directly related to the possibility of developing vascular diseases and logically within them the renal. Therefore, we must be very aware that each and every one of the risk factors are controlled and avoid the so-called therapeutic diagnostic inertia. We all have very clear that our blood pressure, our glucose levels, our control of cholesterol in the analytical is important and we leave for the end the subject of lifestyle habits. Well, smoking, smoking, is so harmful that I would put it before even the rest of the risk factors.
Tobacco and kidney transplant What happens?
The kidney transplant patient is a very special patient due to many conditions. First of all, because it is a patient with chronic kidney disease that has passed to the most important of therapies for chronic kidney disease, which is kidney transplantation. Therefore, it is a patient that has to be very careful in each of the risk factors. And there is no doubt, smoking induces damage in a patient who also has a single functioning kidney and you have to take care of it as "gold in cloth". In addition, in the case of smoking, if the technique and strategy is correct, success is very high. And we have a special condition in the kidney transplant, is that he is taking a lot of medication, is a polymedicated patient and some of the drugs can interact with others. If our kidney transplant patient needs specific therapy for tobacco, he or she must have an important vigilance on the part of the nephrologist when monitoring those possible side effects of the medication to stop smoking, in relation to the immunosuppressants or with the rest of drugs that our kidney transplant recipient can receive. Therefore, it is not contraindicated far from it, but it does require very close monitoring.
What is the best strategy to stop smoking?
In my case, I offer an approach to smoking cessation in a multidisciplinary way, that is, it is very important that the smoker patient is approached along with the rest of the cardiovascular risk factors that present. That is, we must not abandon other medications or forget other side effects that may be related to our patient. That is to say, like any smoker we will assess their physical and psychological dependence and their degree of motivation, but if it is necessary to start a program, we will offer a multidisciplinary program and an individualized program, as it can not be otherwise , more than anything because it is the most effective. In any case, from the consultation, as a coordinating doctor, what I will take is through different techniques: genetic, radiological, something very important is the subject of nutrition. Through a bioimpedanciometría 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 getting fat; that is, we are going to get the weight to stabilize. Some laboratory tests, essential tests to see the side effects of medication, respiratory, as is logical, and peripheral vascularization such as the ankle-brachial index. But most important of all, we do a follow-up program, that is, the patient has a constant ability to contact the doctor to tell him if he has side effects, if he is feeling ill, if he is unmotivated, if he has any dependency problems or of need to consume, because it can be achieved as long as the contact is very close. And for that the program is designed and the success rate is, fortunately, very high.