戒菸對慢性腎臟疾病病人健康維護成效之探討──7年縱貫性研究

Effects of Smoking Cessation on Healthcare Maintenance in Chronic Kidney Disease Patients: A 7-Year Longitudinal Study

目的：吸菸會導致慢性腎臟病病程惡化，並且是許多疾病的危險因子，例如心血管疾病及癌症等。戒菸能夠減緩腎臟功能退化，並廣泛地應用於臨床的疾病防治。本研究旨在探討戒菸衛教對慢性腎臟病吸菸病人於追蹤期間，使用腎臟替代療法、罹患癌症和存活之狀況。方法：縱貫性的追蹤比較研究，採立意取樣以中部某一醫學中心參與戒菸衛教活動的慢性腎臟病吸菸病人為對象，共收案33人，戒菸成功組13位、未成功戒菸組20位，從2008年12月至2015年12月，共追蹤7年。比較兩組的方式進行資料蒐集分析。結果：戒菸成功組與未成功組在使用腎臟替代療法（8位，61.5％ v.s 9位，45.0％，p＞0.05）及罹患癌症的比例無顯著差異（3位，23.1％ vs. 10位，50.0％，p＞0.05）。因癌症死亡方面，戒菸成功組的比例顯著低於未成功組（1位，33.3％ vs. 10位，100％，p0.05），未達統計學上顯著差異。結論：戒菸可延後慢性腎臟病病人因癌症死亡的時間，戒菸不成功的人有較高死亡比例。期待此結果作為醫療人員在執行戒菸計畫時之參考，提升對慢性腎臟病的照護品質。

Purposes: Smoking could worsen chronic kidney disease (CKD) and is also a risk factor for many diseases, such as cardiovascular disease and cancer. In comparison, smoking cessation delays the deterioration of renal function and is widely used in disease prevention. This study aimed to explore the effects of smoking cessation in CKD patients in terms of use of renal replacement therapy (RRT), cancer diagnosis, and survival during follow-up. Methods This study employed a longitudinal comparative panel design. Purposive sampling was used on subjects who received smoking cessation program at a medical center in central Taiwan. There were 33 enrolled participants, of which 11 were ex-smokers and 20 failed to quit smoking (smoking group). The study was conducted from December 2008 to December 2015, with a total follow-up period of 7 years. Data was collected and compared across both groups. Results There were no significant difference in RRT usage (n=8, 61.5% versus n=9, 45.0%, p>0.05) and proportion of subjects who developed cancer (n=3, 23.1% versus n=10, 50.0%, p>0.05) between the two groups. The proportion of cancer mortality was significantly lower in the ex-smoker group than the smoking group (n=1, 33.3% versus n=10, 100%, p0.05). Conclusions This study showed that smoking cessation could help delay cancer mortality in CKD patients as subjects in the smoking group had a higher mortality. These findings may provide a reference to medical staff in executing smoking cessation programs to improve the quality of care for CKD patients.