Quitting Smoking with CKD

Smoking harms kidneys by multiple mechanisms:

• Constricts kidney blood vessels (acutely raises BP)
• Accelerates atherosclerosis of renal arteries
• Increases proteinuria
• Doubles the rate of GFR decline
• Doubles the risk of reaching kidney failure
• Quadruples cardiovascular death (the biggest killer in CKD)
• Worsens diabetic nephropathy specifically
• Reduces transplant kidney survival by 25%
• Slows wound healing — important if you'll need fistula or transplant surgery
• Increases anaemia and reduces erythropoietin response
• Linked to bladder, kidney and renal pelvis cancers

In CKD, smoking is more harmful than uncontrolled BP or high cholesterol.

Within Hours

• Carbon monoxide leaves the blood
• Oxygen delivery to kidneys improves

Within Weeks

• BP starts falling (3–5 mmHg)
• Heart rate slows
• Proteinuria reduces
• Sense of taste and smell return (helpful for renal diet)

Within Months

• Lung function improves 10–20%
• ACR (urine protein) falls
• Anaemia improves
• ESA (erythropoietin) dose may reduce

Within A Year

• Heart attack risk halves
• Rate of CKD progression slows toward non-smoker levels

WITHIN 5–10 YEARS:

• Stroke risk = non-smoker
• Lung cancer risk halves
• Transplant survival approaches non-smoker levels

NICOTINE REPLACEMENT THERAPY (NRT) — safe in all CKD stages:

• 24-hour patches (NiQuitin Clear, Nicorette Invisi) — for steady cravings
• 16-hour patches — if patches cause sleep problems
• 4 mg gum or lozenges — for breakthrough urges (better than 2 mg if heavy smoker)
• Inhalator or mouth spray (Nicorette QuickMist) — for hand-to-mouth habit
• COMBINATION = best success (patch + gum/spray)
• Use for 8–12 weeks minimum
• Free on NHS Stop Smoking Service or low cost from any pharmacy

VARENICLINE (Champix) — most effective:

• Currently temporarily unavailable in UK supply (check with pharmacist for return)
• 12-week course
• Reduce dose if eGFR < 30 (0.5 mg twice daily, not 1 mg)
• Side effects: vivid dreams, nausea — usually mild

BUPROPION (Zyban):

• 7-week course
• Reduce dose if eGFR < 30
• Avoid if history of seizures or eating disorder

CYTISINE (Cytisinicline):

• Plant-based varenicline alternative
• Available privately in UK; NHS access expanding

E-CIGARETTES (vaping):

• PHE endorses for quitting
• Lower risk than tobacco but not zero — aim to quit nicotine eventually
• Refillable open-tank pod systems work better than disposables

NHS STOP SMOKING SERVICES (most effective option):

• 12 weeks of behavioural support
• Free NRT or prescribed medication
• Telephone, online, video or face-to-face
• 4× higher success rate than going alone
• Self-refer: nhs.uk/better-health/quit-smoking
• Or ask your GP for a referral

NHS Quit Smoking App

• Daily progress, money saved, health milestones
• Free download on iOS/Android

Other

• National Smokefree Helpline: 0300 123 1044
• Stoptober campaign (October) — group quitting
• Pregnant smokers: free vouchers available

Your renal team can write a letter for your GP confirming high cardiovascular risk if needed to access varenicline or extended NRT.

SET A QUIT DATE — within 2 weeks. Tell people.

Identify Triggers

• Morning coffee → switch to tea for the first weeks
• After meals → leave the table, brush teeth
• Stress → 4-7-8 breathing, walk
• Alcohol — biggest relapse trigger; reduce in first months
• Other smokers — ask them not to smoke near you for the first month

Manage Withdrawal

• Cravings peak in days 3–5 and last only 3–5 minutes — they pass
• Drink water, suck a mint, go for a walk
• Use NRT EVERY time you would normally smoke
• Mood drops are normal — exercise helps

If You Slip

• Don't write off the whole attempt
• Most successful quitters tried 4–6 times
• Note what triggered it and plan for next time

Renal-specific

• Weight gain after quitting is common (~5 kg) but health benefit hugely outweighs it
• Watch potassium if you increase fruit/snacks to manage cravings
• Your renal team WILL be delighted — tell them