No loss of respect here. We all struggle with quality of life issues - is it worth it to keep doing what we're doing when we're on dialysis? Did we really want to start? If we're here on a regular basis, then we've picked dealing with it to giving up, but that doesn't mean it's an easy choice. Some days, when I'm sick and tired and the bills are stacking up I wonder if I was crazy to think I could do this, but mostly, it's still worth the effort.As for the smoking - well, you do say you've tried to quit. It's not an easy thing to do. You have to decide for yourself if changing your lifestyle is worth the possible long term benefits. There are things that are recommended to slow the progression of kidney disease. I kept my head in the sand for a long time after I was diagnosed, and didn't do any research about things like low protein diets. I wonder now if it would have helped, and it is something I regret. You might want to see what information is out there, and see if any of the changes you can make would work for you. At least that way you would be making an informed decision, even if you don't make any changes.
The standard medical answer -- that you should live your life like a robot and perform every action, no matter how unpleasant or stressful, that is necessary to maximize your health potential -- ignores the very important point that there can be great human happiness in being self-indulgent, spontaneous, and indisciplined. The maximum value you can get out of life is not necessarily achieved by going through all the pain you have to endure to get the full gain of optimal health, but is instead determined by a cost-benefit analysis of the pleasure of not being self-disciplined versus the pleasure of being healthier. Doctors act as though all the value is just on the health side of the equation, which it is not.As for smoking, scientific studies have shown that it can have profoundly relaxing effects for some people, and serves as a psychiatric medication. Schizophrenics have been found to have a much higher per capita use of tobacco than the rest of the population, probably because its positive psychiatric effects make it a kind of medicine for them. So in this sense there is a mental health benefit of smoking, which has to be factored into the balance against the known health risks of smoking. Smokers also have a much lower risk of Alzheimer's disease than non-smokers do, which is something the health police never like to tell people, and this also has to be considered.In my own life, I have always chosen the route of self-discipline over self-indulgence in an effort to maximize health potential, but I recognize that that is not necessarily the optimal choice for everyone. The cost-benefit analysis varies from person to person, according to how much pain they experience from self-denial, an how much pleasure they feel from indulging their present needs. I have to assume that each person makes the rational choice for himself.