Nicotine Replacement Therapy in Kidney Disease

Introduction to Nicotine Replacement Therapy

The American College of Cardiology recommends that nicotine replacement therapy, including gum, can be safely used in patients with impaired kidney function without dose adjustment, as the benefits of smoking cessation far outweigh any theoretical risks from nicotine replacement in kidney disease 1, 2

The American Journal of Transplantation guidelines suggest that five nicotine replacement products are effective and can be used in combination in patients with chronic kidney disease and kidney transplant recipients 3, 4, 6
No drug interactions exist between nicotine replacement therapies and immunosuppressive agents in transplant patients, according to the American Journal of Transplantation 6, 7

Smoking is associated with faster progression of chronic kidney disease and cardiovascular disease in this population, as stated by the Annals of Internal Medicine 1, 2
In kidney transplant recipients, smoking independently predicts worse patient survival, graft survival, ischemic heart disease, cerebrovascular disease, and malignancy, according to the American Journal of Transplantation 8, 7

The American Journal of Transplantation recommends screening all kidney disease patients for tobacco use at each visit, including during initial hospitalization for transplantation 3, 4, 5
The Journal of the American College of Cardiology suggests providing counseling, developing a quit plan, and arranging pharmacotherapy, including nicotine replacement 9
Combination nicotine replacement therapy, such as patch plus gum, can be used for maximum effectiveness, as recommended by the American Journal of Transplantation 3, 4, 6